A new procedure with stomach-lifting techniques to simplify laparoscopy-assisted distal gastrectomy and extraperigastric lymph node dissection for gastric cancer
A new procedure with stomach-lifting techniques to simplify laparoscopy-assisted distal gastrectomy and extraperigastric lymph node dissection for gastric cancer
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一种新的胃提升技术手术，可简化腹腔镜辅助远端胃切除术和胃外淋巴结清扫术治疗胃癌
DOI：
10.1007/s00595-008-3780-0
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发表时间：
2009
期刊：
影响因子：
2.5
通讯作者：
M. Kitajima
中科院分区：
文献类型：
--
作者：
Tatsushi Suwa;Masashi Yoshida;K. Kubota;J. Kuroda;M. Sakuma;M. Kitajima
腹腔镜辅助胃癌切除术联合胃周淋巴结清扫术是一种复杂的手术，通常需要先进的腹腔镜外科技术。我们设计了一种简化但有效的腹腔镜手术，提供了更好的视野，更快地进行安全的淋巴结清扫。首先，做一个小型剖腹手术，通过向右或向左拉一个小型牵开器来创造一个清晰的视野。腹腔镜手术更容易和更安全，通过用胶带绑住胃体，并使用放置在胃后面的腹壁密封装置（Lapdisk）的边缘和蛇牵开器的范围保持器。然后通过腹腔镜解剖沿着肝总血管、胃左血管和腹腔动脉的淋巴结（胃周外淋巴结）。幽门上和幽门下淋巴结通过小剖腹手术切口和胃十二指肠吻合术是用吻合装置完成。我们对70例远端胃癌患者（平均体重指数：24.3）进行了腹腔镜辅助远端胃切除术（LADG）。平均手术时间为170分钟，失血量极少。所有患者恢复良好，疼痛轻微，术后生活质量良好。我们的结论是，我们的简单和实用的程序LADG胃周淋巴结清扫术可以安全和容易地进行。
Laparoscopy-assisted gastrectomy with extraperigastric lymph node dissection for gastric cancer is a complicated procedure that generally requires advanced laparoscopic surgical skill. We devised a simplified but effective laparoscopic procedure that provides a better visual field to perform safe lymph node dissection more quickly. First, a mini-laparotomy is done and a clear visual field is created by pulling a mini-retractor to the right or left. The laparoscopic procedure is made easier and safer by taping the stomach body, and by using the fringe of an abdominal wall sealing device (Lapdisk) placed behind the stomach, and a scope holder for the snake-retractor. The lymph nodes along the common hepatic vessels, left gastric vessels, and celiac artery (extraperigastric lymph nodes) are then dissected laparoscopically. The suprapyloric and infrapyloric lymph nodes are dissected through the mini-laparotomy incision and gastroduodenostomy is done using an anastomotic device. We performed laparoscopy-assisted distal gastrectomy (LADG) in 70 patients with gastric carcinomas located in the distal stomach (mean body mass index: 24.3). The mean operating time was 170 min and blood loss was minimal. All patients recovered well with minimal pain and good postoperative quality of life. We conclude that our simple and practical procedure for LADG with extraperigastric lymph node dissection can be performed safely and easily.