腹腔镜靠近总D2的全胃切除术

腹腔镜靠近总D2的全胃切除术
Laparoscopic Near Total D 2 Gastrectomy

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博士AC Thanakumar，减肥和
全球医院胃肠外科，晨奈病人谁经历了胃窦切除术迷走神经切断术，20年前提出与胃癌有几个LN扩大。他接受了近全胃切除术，腹腔镜下D2淋巴结清除。技术涉及到两个纱布块，以解除身体的胃关闭胰腺的淋巴结清扫术。过程涉及到以前的输入袢空肠的空肠anastamosis之间的传入和传出的的Ĵ循环分工及其附件的传出空肠与胃胃大部切除术完成手术订书机部门的致密粘连，粘连尽可能高的D2清除LN和胃肠道空肠anastamosis一侧到另一侧用Endo GIA校准管。路径显示不佳差异胃癌9 LN参与了肿瘤病人出院6天的时间和钡的研究在第一次门诊审查发现小残胃与充足的anastamosis。
Dr John AC Thanakumar,
Senior Consultant in Minimal Access, Bariatric and GI Surgery
Global Hospital, Chennai

Patient who had undergone antrectomy with vagotomy 2 decades ago presented with stomach carcinoma with a few LN enlarged. He underwent Laparoscopic Near Total Gastrectomy with D2 Lymph Nodal Clearance.

Technique involves two gauze pieces to lift the body of the stomach off the pancreas for lymph nodal dissection. Procedure involves
adhesiolysis of the dense adhesions of previous surgery
stapler division of the afferent loop
jejuno jejunal anastamosis between the afferent and efferent J loops
division of the efferent jejunum at its attachment with stomach
completion of gastrectomy as high as possible with D2 clearance of LN and
gastro jejunal anastamosis- side to side with endo GIA over calibration tube.

Path revealed poorly diff carcinoma of stomach with 9 LN involved with tumor.

Patient was discharged in 6 days time and the barium study during the first opd review revealed a small remnant stomach with an adequate anastamosis.

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