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腹腔镜治疗腹腔内恶性肿瘤仍存在不少争议,焦点是气腹和器械的接触会引起腹膜播散。 在大量实验研究基础上形成的远端胃次全切除和胃周淋巴结清扫(D1)技术,可在胃左动脉根部分离结扎,并作网膜切除。消化道重建选用悬吊残胃于腹壁的BillrothⅡ式胃空肠侧侧吻合法。 手术技术 手术在气管插管的全麻下进行,并放置胃管。患者取仰卧位,双腿分开,同时作腹腔镜和剖腹手术准备。术者位于患者两腿之间,两名助手分别在患者两侧。 脐周穿刺造气腹,压力为10mmHg。然后经此穿刺孔置人11mm腹腔镜套管以放置镜头。作其他穿刺孔之前先用100ml 37℃生理盐水冲洗腹腔,作细胞学检查。同时彻底探查腹腔以发现肿瘤种植以及浆膜和肝脏侵犯情况。如符合腹腔镜手术指征,术者即在直视下置入另4个套管:脐旁右锁骨中线置入12mm套管;左锁骨中线同样位置置人15mm套管;左肋缘下腋前线和剑突下各置人一10mm套管。
Laparoscopic treatment of intra-abdominal malignancies is still controversial, with the focus being that contact between the pneumoperitoneum and the device can cause peritoneal dissemination. Based on a large number of experimental studies, distal subtotal gastrectomy and perianal lymph node dissection (D1) techniques can be performed to separate and ligate the left gastric artery and omentum. For the reconstruction of the digestive tract, a Billroth type II gastrojejunal side-to-side anastomosis method was used to suspend the remnant stomach on the abdominal wall. Surgical techniques Surgery is performed under general anesthesia with tracheal intubation and gastric tubes are placed. The patient was placed in a supine position with her legs separated and at the same time prepared for laparoscopic and laparotomy. The surgeon is located between the patient’s legs and the two assistants are on both sides of the patient. Umbilical puncture creates pneumoperitoneum and the pressure is 10mmHg. Then, a 11 mm laparoscope cannula was placed through this puncture hole to place the lens. Before performing other punctures, the abdominal cavity was washed with 100 ml of physiological saline at 37°C for cytological examination. At the same time, a thorough exploration of the abdominal cavity was performed to discover tumor growth and serosa and liver invasion. In accordance with indications for laparoscopic surgery, the surgeon placed four additional cannulas under direct vision: a 12mm cannula was inserted into the midline of the right clavicle and a 15mm cannula was placed in the same position of the left midclavicular line; A 10mm cannula was placed on the front and under the xiphoid.