减重手术-袖状胃切除术

Bariatric surgery-Sleeve gastrectomy

距幽门2 cm开始紧贴胃大弯壁用超声刀离断大网膜,同时充分游离胃后壁与胰腺之间粘连,直至胃底,显露出左侧膈肌脚及食道左侧。经口置入36 F粗胃管,沿胃小弯直至到达胃窦处,距幽门4~6 cm开始用成钉高度较高的内镜下直线切割闭合器进行袖状胃裁剪,然后换用为钉腿高度较低的内镜下直线闭合器切割,切割线距离胃管边缘1 cm,在胃底部离食道左侧缘1~2 cm处离断胃底。用倒刺缝合线连续浆肌层缝合加固胃切缘,可将大网膜一并缝合在胃切缘。移除胃管,清理腹腔,扩大主操作孔,取出切除的胃组织,在左侧膈肌脚放置引流管,用不可吸收线全层缝合10 mm及12 mm戳卡孔。

The greater omentum was dissected by using ultrasound knife along greater curve 2 cm away from Pylorus,and the adhesion between the posterior wall of the stomach and the pancreas was fully dissected until the gastric fundus,the left foot of the diaphragm and the left side of the esophagus were exposed.36 F gastric tube was inserted along the small curvature of the stomach until it reached the antrum.the sleeve shaped stomach was dissected 4~6 cm away from the pylorus by using linear staplers according to the thickness of gastric wall.The cutting line was 1 cm away from the edge of the gastric tube,and 1~2 cm away from the left edge of the esophagus at gastric fundus.The greater omentum could be sutured at the incision edge of the stomach,then as following to remove the gastric tube,to clean the abdominal cavity,to enlarge the main operation hole,to take out the excised gastric tissue,to place the drainage tube at the left diaphragm foot,finally to close 10 mm and 12 mm Trocar holes by non-absorbable suture.