全腔镜全胃切除术

Totally Laparoscopic Total Gastrectomy

切开胃结肠韧带,游离至脾脏下极,于根部离断胃网膜左血管,清扫第4组淋巴结,离断胃短血管直至脾上极。游离胃窦部,于胰腺上缘离断胃网膜右静脉,显露胃十二指肠动脉后,于根部离断胃网膜右动脉,并完成第六组淋巴结的清扫。显露胃窦后壁,离断胃右血管,清扫肝门部淋巴结。距幽门2 cm离断十二指肠。沿胰腺上缘解剖脾动脉根部,于根部离断胃左静脉。显露腹腔干及胃左动脉,向右侧清扫第8组淋巴结,于根部离断胃左动脉后,向头侧清扫第1,2组淋巴结。游离食管腹段,解剖出迷走神经左右支后离断。悬吊肝左叶后,距贲门2 cm离断食管,取上腹正中辅助切口3 cm,移除胃标本及大网膜。重建气腹后,距TREIZ韧带20 cm离断空肠,行食管左后壁与近端空肠侧侧吻合(OVERLAP法),手工缝合共同开口。距此吻合口40 cm,借助辅助切口完成小肠侧侧吻合(ROUX-Y)吻合。

Opening gastrocolic omentum and dissociating to the spleen on the left,we broke left gastroepiploic vessels and cleaned the fourth group of lymph nodes.We dissociated and broken short gastric vessels and got to the upper pole of the spleen.Dealing with antrum of stomach,we broke right gastroepiploic artery and vein with cleaning the sixth group of lymph nodes.After exposing the back wall of antrum,we broken right gastric vessels and cleaned the lymph nodes near porta hepatis.Breaking duodenum at 2 cm from pylorus.We broke left gastric vein and cleaned the eighth group of lymph nodes,and broke left gastric artery with cleaning the firth and second group of lymph nodes.After dealing with the abdominal segment of esophagus,we separated and broke vagus.Following suspending left hepatic lobe,we broke esophagus at 2 cm from cardia of stomach.We took out excised stomach and omentum majus through auxiliary incision,which were checked in pathology.After establishing pneumoperitoneum again,we broke jejunum at 20 cm from TREIZ ligament and link esophageal and small intestine with OVERLAP method,in which collective mouth was manually sutured.We completed side-to-side anastomosis of small intestine at 40 cm from anastomosis and sutured mouth on mesentery of the small intestine with help from auxiliary incision.Surgery over.