腹腔镜胃癌根治术中胃网膜右系膜分离的体会  

Experience of dissecting the right gastroepiploic mesentery inmembrane anatomy-guided laparoscopic radical gastrectomy

作　　者：钟新强 覃吉超 肖海鹏 陆艳军[1] 孙震 孙鑫盟 ZHONG Xinqiang;QIN Jichao;XIAO Haipeng(Department of Gastrointestinal Surgery,Hubei Huanggang Central Hospital,Huanggang 438000,China;Department of Gastrointestinal Surgery,Tongji Hospital,Tongji Medical College of HUST)

机构地区：[1]黄冈市中心医院胃肠外科,湖北黄冈438000 [2]华中科技大学同济医学院附属同济医院胃肠外科

出　　处：《腹腔镜外科杂志》2024年第1期27-31,共5页Journal of Laparoscopic Surgery

基　　金：国家自然科学基金面上项目(82173368);国家自然科学基金面上项目(82372995)。

摘　　要：目的:探讨腹腔镜胃癌根治术中胃网膜右系膜分离及完整切除的可行性及应用价值。方法:回顾分析35例腹腔镜胃癌根治术(膜解剖术式)患者的临床资料,其中19例行腹腔镜远端胃根治性切除术,16例行腹腔镜全胃根治性切除术。记录胃网膜右系膜分离时间、术中出血量、清扫淋巴结数量、术后相关并发症情况、术后恢复情况等。结果:35例手术均获成功,胃网膜右系膜分离手术时间14~25 min,平均(17.1±2.1)min;分离胃网膜右系膜出血量2~20 mL,平均(5.0±2.7)mL;胃网膜右系膜处淋巴结清扫数量3~8枚,平均(5.2±2.1)枚。术后发生吻合口出血、切口感染、肺部感染各1例,均经保守治疗治愈,无手术死亡病例。结论:在深刻理解膜解剖理论、手术流程相对固定及手术技巧熟练的前提下,腹腔镜胃癌根治术中可实现胃网膜右系膜分离与完整切除。Objective:To investigate the feasibility and application value of dissection and complete resection of the right gastroepiploic mesentery in laparoscopic radical gastrectomy.Methods:The clinical data of 35 cases of laparoscopic radical gastrectomy(based on membrane anatomy)were analyzed retrospectively.Among them,19 patients with gastric cancer underwent laparoscopic radical distal gastrectomy,and 16 patients with gastric cancer underwent laparoscopic radical total gastrectomy.The dissection time,intra-operative blood loss,the number of harvested lymph nodes of the rightgastroepiploic mesentery,postoperative complications and postope-rative recovery were recorded.Results:All 35 patients successfully underwent laparoscopic radical gastrectomy.The time of dissecting the right gastroepiploic mesentery was 14-25 min,with an average of(17.1±2.1)min.The blood loss from dissecting the right gastroepiploic mesentery was 2-20 mL,with an average of(5.0±2.7)mL.The number of lymph nodes at right gastroepiploic mesentery was 3-8,with an average of(5.2±2.1).Postoperative anastomotic bleeding occurred in 1 case,incision infection occurred in 1 case,pulmonary infection occurred in 1 case,all were cured by conservative treatment,and there was no operative death.Conclusions:With a deep understanding of membrane anatomy,relatively fixed surgical protocol and proficient operative techniques,dissection and complete r esection of the right gastroepiploic mesentery can be performed in laparoscopic radical gastrectomy.

关 键 词：胃肿瘤 胃癌根治术 腹腔镜检查 膜解剖 胃网膜右系膜 

分 类 号：R735.2[医药卫生—肿瘤]