胃后系膜在腹腔镜胃外科手术中的应用

Application of posterior gastric mesentery in laparoscopic gastric surgery

胃后系膜是膜解剖理论中胃的六大系膜之一,它位于胰腺上区,包绕胃后血管,左邻胃短系膜,右靠胃左系膜,将胃底体部固定于胰腺上区的后腹壁。由于其解剖结构,在完整系膜切除(CME)+D_(2)中,它是处理胰腺上区胃系膜的手术入路;"黄氏三步法"的第二步与膜解剖的胃后系膜部分相对应。在良性疾病腹腔镜袖状胃切除术(LSG)和腹腔镜胃底Nissen折叠术中,若遇到胃短血管难以暴露和安全离断时,先离断胃后系膜,挑起胃底体有助于离断胃短血管。膜解剖理论作为一种前沿理论,在胃外科手术中为我们提供新的手术视角和路径。

The posterior gastric mesentery is one of the six mesenteries of the stomach in the membrane anatomy theory.It locates in the upper area of the pancreas,surrounds the posterior gastric vessels,and is adjacent to the short gastric mesentery by the left side,and is adjacent to the left gastric mesentery by the right side,which fixes the fundus body to the posterior abdominal wall of the upper area of pancreas.Due to its anatomical structure,in complete mesentery excision(CME)+D_(2) surgery,it is a surgical approach to deal with gastric mesentery in the upper area of pancreas;the second step of the"Huang's three-step method"corresponds to the posterior gastric mesentery in the theory of membrane anatomy.In the surgery of benign diseases of the stomach,laparoscopic sleeve gastrectomy(LSG)and laparoscopic Nissen fundoplication,if the short gastric vessels are difficult to be exposed and safely divided,we can dissect the posterior gastric mesentery firstly,and then hoist the fundus of the stomach in order to help dissection of the short gastric vessels.The membrane anatomy theory,as a frontier theory,provides us the new surgical perspectives and paths in gastric surgery.