全胃切除术的手术步骤有哪些 闫志峰 山西省肿瘤医院 скачать в хорошем качестве

全胃切除术的手术步骤有哪些 闫志峰 山西省肿瘤医院

全胃切除术的手术步骤有哪些 闫志峰 山西省肿瘤医院 全胃切除术的手术步骤有以下几点：第一、上腹部正中切口，在脐上一厘米横行切开腹直肌，前鞘一厘米，即可确定白线的位置和宽度，如果方向感较差，向上切开依然会偏离中线，那么切开剑突底下一横口；第二、探查，首先探查脾脏、肝、盆腔有无转移结节，然后探查胃、肿瘤的大小，注意肿块距离幽门和贲门的距离，特别注意贲门的位置需要靠血管确定，切开肝、胃、脾无血管区，探查与胰腺的关系，幽门部的肿瘤要注意与肝十二指肠韧带的关系，提起横结肠，观察结肠中动脉是否被侵犯，如果大量肿大的淋巴结要特别注意胃左动脉根部，还有多大间隙，根据探查结果判断肿瘤是否能切除，切除的难点何在，淋巴结的清扫范围按顺序从左向右、从下向上、从前向后依次探查。 What are the operation steps of total gastrectomy The operation steps of total gastrectomy are as follows: first, midline incision of upper abdomen, Cut the rectus abdominis one centimeter across the navel, Anterior sheath 1 cm, The position and width of the white line can be determined, If the sense of direction is poor, The upward incision will still deviate from the midline, Then cut a horizontal opening under the xiphoid; Second, exploration, First, the spleen, liver and pelvis were examined for metastatic nodules, Then the size of the stomach and the tumor were detected, Note the distance between the mass and the pylorus and cardia, Especially, the position of the cardia should be determined by blood vessels, Open the avascular area of liver, stomach and spleen, To explore the relationship with pancreas, The relationship between pylorus tumor and hepatoduodenal ligament should be noted, Lift the transverse colon, Observe whether the middle colon artery is invaded, If a large number of enlarged lymph nodes, pay special attention to the root of left gastric artery, What's the gap, According to the results of exploration, we can judge whether the tumor can be removed, What are the difficulties of resection, The range of lymph nodes was explored from left to right, from bottom to top, from front to back.