腹腔镜辅助胃癌D2根治性全胃切除术  

Laparoscopy-assisted total gastrectomy with D2 lymph node dissection

作　　者：杜建军[1] 郑建勇[1] 李纪鹏[1] 季刚[1] 陈冬利[1] 刘小南[1] 李秦[1] 冯全新[1] 靳朝辉[1] 高志清[1] 王为忠[1] 

机构地区：[1]第四军医大学西京医院普通外科,西安710032

出　　处：《中华普通外科杂志》2008年第1期1-4,共4页Chinese Journal of General Surgery

摘　　要：目的探讨腹腔镜辅助下D2淋巴结清扫全胃切除术的手术要点。方法根据我院2005年7月至2007年4月期间61例腹腔镜辅助下D2淋巴结清扫全胃切除术患者的临床资料，对腹腔镜辅助下D2淋巴结清扫全胃切除的手术要点进行归纳分析。结果本组61例接受腹腔镜辅助下D2淋巴结清扫全胃切除术的患者均无中转开腹，无手术死亡，无严重的手术并发症。手术中应着重遵循以下几点：（1）避免损伤横结肠；（2）避免损伤胰头下缘；（3）先离断胃左静脉，清扫完第7、8a、9、11P组淋巴结后，最后离断胃左动脉；（4）准确无误离断胃右动脉；（5）避免清扫腹腔动脉旁淋巴结时出血；（6）避免分离脾胃韧带时出血；（7）找对间隙，分离贲门及胃底。结论了解进展期腹腔镜辅助胃癌D2淋巴结清扫全胃切除的手术要点，对顺利开展腹腔镜辅助下胃癌D2淋巴结清扫全胃切除术有益。Objective To sum up our experience in performing laparoscopy assisted total gastrectomy （ LATG ） with D2 lymph node dissection. Method Between January 2005 and April 2007, 61 patients with advanced gastric cancer underwent LATG. Results There was not conversion to open surgery in this 61 patients. There was no perioperative mortality and no severe complications. The following is key points in performing a successful procedure. 1. To avoid injury of trans-colon. 2. To avoid injury of inferior border of the pancreas. 3. Left gastric vein was to be divided and ligated first, then group 7, 8a, 9, and 11p lymph node dissection completed. 4. Right gastric artery was divided. 5. To avoid bleeding when dissecting group 9 lymph node. 6. To avoid bleeding when dividing gastroepiploic vessels. 7. Cardia and fundus of the stomach were freed through correct cleavage. Conclusions The grasping of these technical know-bows are condusive to a successful laparoscopy-assisted total gastrectomy with D2 lymph node dissection.

关 键 词：胃肿瘤 腹腔镜检查 胃切除术 淋巴结清扫术 

分 类 号：R686[医药卫生—骨科学]