经阴道取标本的完全腹腔镜远端胃D_(2)切除术:附二例报告

Total laparoscopic distal D_(2)gastrectomy with transvaginal specimen extraction:a report of 2 cases

目的探讨经阴道取标本的完全腹腔镜远段胃D_(2)切除术的手术适应证、禁忌证及操作要点。方法回顾性分析武汉市第一医院胃肠外科2019年11月至2019年12月完成的胃下部癌病人的临床资料和手术过程。结果2例病人均顺利完成完全腹腔镜下远端胃D_(2)切除、消化道重建及经阴道取标本,术后无近期并发症,随访期内均无远期并发症,无瘤生存,生活质量良好。结论如具有丰富的常规腹腔镜手术经验,术中能够确保严格遵守无菌术与无瘤术的技术要求,并能够熟练完成全腹腔镜下消化道重建,严格把握适应证和禁忌证,开展经阴道取标本的完全腹腔镜远端胃D_(2)切除术是安全可行的,创伤更小、美学效果更好。

Objective To explore the surgical approach of total laparoscopic distal gastrectomy with transvaginal specimen extraction and summarize its indications,contraindications and operative essentials.Methods From November 2019 to December 2019,clinical data and surgical procedures of patients with lower gastric cancer were retrospectively analyzed.Results Two patients successfully completed total laparoscopic distal D_(2)gastrectomy,digestive tract reconstruction and transvaginal specimen extraction.There was no short/long-term complication during follow-ups.Both survived tumor-free with an excellent quality-of-life.Conclusion With rich experiences in conventional laparoscopy,strict compliance with technical requirements of aseptic surgery and tumor-free surgery,surgeons may skillfully complete total laparoscopic digestive tract reconstruction,strictly grasp the indications and contraindications and perform laparoscopic distal D_(2)gastrectomy with vaginal specimen extraction.It is safe,feasible and min-invasive with better aesthetic outcomes.