腹腔镜胃癌根治术中胃右系膜完整切除的体会  

Experience in complete resection of rightmesogastrium in laparoscopic radical gastrectomy

作　　者：肖海鹏 陆艳军[1] 钟新强 乐逵 覃吉超 XIAO Haipeng;LU Yanjun;ZHONG Xinqiang(Department of Gastrointestinal Surgery,Huanggang Central Hospital,Huanggang 438000,China)

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32-34,59,共4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右系膜完整切除的体会。方法:收集2022年3月至2022年12月行基于膜解剖的3D腹腔镜根治性远端胃及全胃切除术的58例患者的临床资料,其中42例离断十二指肠后显露门静脉,切除门静脉前方的胃右系膜;16例于离断十二指肠前显露门静脉,切除门静脉前方的胃右系膜。记录胃右系膜内的淋巴结数量、术后相关并发症及术后恢复情况。结果:58例胃癌患者均在腹腔镜下成功完成胃右系膜的完整分离、血管离断。胃右系膜平均清扫淋巴结(1.2±0.5)枚。标本病理检查结果显示胃右系膜内淋巴结均为阴性。术后出现吻合口出血1例、胃瘫1例,均经保守治疗后治愈出院。结论:从后方将胃右系膜抬起分离,较从前方分离能更好、更完整地分离胃右系膜。离断十二指肠前或后完成门静脉前方胃右系膜的切除各有优势,离断前切除出血较少,离断后切除视野较开阔;完成门静脉前方胃右系膜切除时应防止过度牵拉导致胆总管牵拉从而损伤胆总管。Objective:To summarize the experience of complete resection of the right mesogastrium in laparoscopic radical gastric cancer surgery.Methods:From Mar.2022 to Dec.2022,clinical data of 58 patients who underwent membrane anatomy-guided radical distal gastrectomy and total gastrectomy under 3D laparoscopy were collected.In 42 cases the portal vein was exposed after resection of the duodenum,right mesogastrium was finally resected in front of the portal vein,and in 16 cases the portal vein was exposed before resection of the duodenum,the right mesogastrium was resected in front of the portal vein.The number of lymph nodes in the right mesogastrium,postoperative complications and postoperative recovery were recorded.Results:The right mesogastrium was completely separated and vessels were resected in all the 58 patients.The average number of lymph nodes dissected in the right mesogastrium was(1.2±0.5).The pathological examination results of the specimens showed that the lymph nodes in the right mesogastrium were negative.One case suffered from anastomotic bleeding and one case developed gastroparesis after surgery,both were cured and discharged after conservative treatment.Conclusions:After lifting the right mesogastrium from the back,the right mesogastrium can be better and completely separated than after separating it from the front.Before or after the duodenum is excised,the resection of the right mesogastrium in front of the portal vein has its own advantages.The right mesogastrium resection before excising duodenum has less bleeding,and the surgical field is broader after excising duodenum.When completing the right mesogastrium resection in front of the portal vein,the damage of the common bile duct due to excessive pull should be prevented.

关 键 词：胃肿瘤 胃癌根治术 腹腔镜检查 胃右系膜 膜解剖 

分 类 号：R735.2[医药卫生—肿瘤]