腹腔镜下解剖学思路在腹腔镜辅助远端胃癌D2根治术的运用  

Thinking of laparoscopic anatomy of laparoscopic distal 1）2 radical gastrectomy

作　　者：王大广[1] 何亮[1] 张洋[1] 于金海[1] 陈岩[1] 夏明杰[1] 所剑[1] 

机构地区：[1]吉林大学第一医院胃肠外科,长春130021

出　　处：《中华外科杂志》2013年第11期991-995,共5页Chinese Journal of Surgery

摘　　要：目的探讨腹腔镜辅助远端胃癌D2根治术中解剖学思路的应用。方法回顾性分析2009年1月至2012年1月接受腹腔镜远端胃癌D2根治术的349例患者的临床资料，其中男性180例，女性169例，年龄29～86岁，平均年龄（57±3）岁，体重指数20．5～32．8kg／m2，平均（26．0±2．0）kg／m2，总结手术中的相关解剖学思路。结果5例患者因过度肥胖中转开腹，其余344例患者均行腹腔镜远端胃癌D2根治术，分为7个解剖学视野进行操作。患者手术时间120～210min，术中出血量50—200ml。术后出现并发症11例，包括十二指肠残端漏5例，胃瘫2例，小肠梗阻3例，腹腔出血1例，所有患者均顺利出院。结论采用分区、由表及里的解剖，更有利于掌握腹腔镜胃癌根治术的操作及规范化清扫，对提高手术效率，缩短手术学习曲线，提高手术质量有重要作用。Objective To discuss laparoscopic assisted radical D2 resection of distal gastric anatomy application ideas. Methods Collected the clinical data from January 2009 to January 2012 who underwent laparoscopic distal gastric resection in patients with D2 349 cases. There were 180 male and 169 female patients, and the age were （57 ± 3 ） years old （ range 29-86 years ）, the body mass index of patients were （26. 0 ± 2. 0 ） kg/mz （ range 20. 5-32. 8 kg/m2 ）. The relevant surgical anatomy ideas had summarized. Results In addition to 5 cases of obese patients with conversion to open, the remaining patients underwent laparoscopic distal gastric D2 resection. The operation is divided into 7 operating anatomical view. The operation time were 120-210 minuctes and the blood loss were 50-200 ml. Postoperative complications occurred in 11 cases, including 5 cases of duodenal stump leakage, 2 cases of gastroparesis, 3 cases of small bowel obstruction, and abdominal bleeding in 1 case. All patients were discharged. Conclusions Use zoning, exterior to interior of the anatomy, more conducive to master the operation of laparoscopic radical gastrectomy and standardized cleaning, to improve the operation efficiency and shorten the surgical learning curve and improve the quality of surgery has an important role.

关 键 词：胃肿瘤 腹腔镜检查 解剖学 局部 

分 类 号：R735.2[医药卫生—肿瘤]