腹腔镜胃袖状切除术  

Laparoscopic sleeve gastrectomy

作　　者：李智飞[1] 陶明[1] Li Zhifei;Tao Ming(Peking University Third Hospital,Peking 100091,China)

机构地区：[1]北京大学第三医院,100091

出　　处：《中华普外科手术学杂志（电子版）》2021年第6期607-607,共1页Chinese Journal of Operative Procedures of General Surgery(Electronic Edition)

摘　　要：采用腹腔镜三孔法进行手术。悬吊肝脏,简单探查后,患者内脏沉积脂肪较多。从胃角切迹对应胃大弯,紧贴胃壁大弯侧离断大网膜。向下游离至距幽门上方3cm处(使用5cm缝线比对);继续沿胃大弯向头侧游离,贴胃壁切断胃短血管,显露HIS角,打开HIS角处腹膜,游离(或部分切除)食管胃结合部前方脂肪垫,以清晰显露胃食管结合处左侧缘。经口置入F36粗胃管(Bougie管)至幽门(或通过幽门),将Bougie管推向小弯侧,自幽门上4~5 cm处,依次使用切割闭合器沿Bougie管垂直离断大弯侧大部分胃组织,直至胃食管结合部左侧缘外0.5~1 cm处。近幽门侧组织较厚,使用了3排不等高的钉仓。由于胃底体存在与饱腹感相关的压力感受器与分泌胃肠激素的腺体,充分少胃组织的容量积经量全切除胃底是十分重要的。最后在腔镜下使用倒刺线连续浆肌层加缝包埋残端,使得切缘处充分浆膜化。可见减少切缘出血及最大程度上减少吻合口漏,这一少见但严重的并发症。The operation was performed with a three-hole laparoscope.After liver suspension and simple exploration,the patient had more visceral fat deposition.From the opposite side of angular incisure to greater curvature of stomach,cut off the greater omentum by the stomach wall’s greater curvature side.Starting from the greater omentum,dissociate downward to 3cm above pylorus(comparing with 5cm sutures)and continue toward to the head side.The short gastric arteries was cut off by the stomach wall and the His angle was exposed.Opening the peritoneum at His angle and dissociating or partial excision the Fad Pad in front of EGJ in order to fully expose the left margin of EGJ.A 36-Fr bougie was placed to or pass the pylorus orally and pushing it to the lesser omentum side.From the 4 or 5cm above pylorus,most of the gastric tissue was dissected vertically along the Bougie tube by stapling device until 0.5~1 cm outside the left edge of the EGJ.The proximal pyloric tissue is thicker so three rows of varied height staplers were used.Adequate reduction of gastric tissue volume is necessary due to the presence of satiety associated pressure receptors and gastrointestinal hormone secreting glands.Finally,under endoscopy,V-Loc string was used to cover the stump,so that the cutting edge was fully folding.Minimizing anastomotic fistula-a rare but serious complication.

关 键 词：肥胖症 减重与代谢手术 腹腔镜胃袖状切除术 

分 类 号：R73[医药卫生—肿瘤]