摘要
自腹腔镜下探查原发灶及腹盆腔是否有转移灶；横结肠上缘近中央处入路分离胃结肠韧带，向左分离至结肠脾曲，向右分离至结肠肝曲。随后在吲哚菁绿引导下行腹腔镜F淋巴结清扫：依次裸化并离断胃网膜右静脉及胃网膜右动脉，完成幽门下区域淋巴结清扫。从胰腺上缘左侧，打开胃胰襞进入胰后间隙，分离显露脾动脉起始段，清扫No.11p组淋巴结；向左裸化并离断胃左动脉，清扫No.7和No.9淋巴结；整块清除肝总动脉前上方的脂肪淋巴组织，完成No. 8a淋巴结清扫；继续向左清扫No.5和No.12a淋巴结，完成胰腺上缘区域淋巴结清扫。“黄氏三步法”分别清扫脾下极、脾动脉干及脾上极区域淋巴结。吲哚菁绿荧光显影检查是否有淋巴结残余。最后在腹腔镜下行食管空肠Rou-en-Y吻合。
Abstract
Using laparoscopy to investigate the primary lesion and determine whether there was a metastasis in the abdominal pelvis. The gastrocolic ligament was separated through the approach near the central margin of the transverse colon. Separated the gastrocolic ligament to the splenic flexure of colon in the left and hepatic flexure of colon in the right. Indocyanine green (ICG)-guided laparoscopic lymphadenectomy was then performed. Naked and cut off the right gastroepiploic vein and the right gastroepiploic artery in order to complete the lymph node (LN) dissection in the infrapyloric region. Opened the gastropancreatic fold and went into the posterior space of the pancreas from the left side of the suprapancreatic area. Then separated and exposed the initial segment of the splenic artery, and cleaned the No.11p LNs. Naked and cut off the left gastric artery, and cleaned the No.7 and No.9 LNs. Removed the fatty tissues and LNs above the anterior common hepatic artery totally to complete the No.8a LN dissection. Dissected the No.5 and No.12a LNs to the left to complete the suprapancreatic LN dissection. According to the Huang's three-step maneuver, removed the LNs of the inferior pole region of spleen, region of splenic trunk and superior pole region of the spleen, respectively. ICG fluorescence examined whether there was residual LN. Finally, Roux-en-Y esophagojejunostomy was performed under laparoscopy.
基金项目
国家自然科学基金(82073187)
福建省医疗“创双高”建设经费(MWYZ[2021] 76)
万方数据