全腹腔镜全胃切除术消化道重建的热点问题和理性思考

Hot issues and rational reflection on digestive tract reconstruction after totally laparoscopic total gastrectomy

  • 摘要: 全腹腔镜全胃切除术在技术的演进中安全性和标准化尚待确立。临床研究和技术创新,为进展期胃癌行腹腔镜全胃切除术的成熟开展奠定了强有力的基础。笔者认为:完善的D2、D2+淋巴结廓清技术(脾门、下纵隔、腹主动脉周围淋巴结廓清),合理选用具有抗反流、食物储存能力、患者拥有最佳生命质量的消化道重建方式,以及安全的食管空肠吻合缝合法是全腹腔镜全胃切除术消化道重建中的焦点问题。

     

    Abstract: The safety and standardization in the technical evolution of totally laparoscopic total gastrectomy are yet to be established. Clinical researches and technical innovations have laid a solid foundation for the maturity of totally laparosco pic total gastrectomy for the patients with advanced gastric cancer.In the view of the author, focus issues of digestive tract reconstruction after totally laparoscopic total gastrectomy include D2、D2+lymph node dissection technology (splenic lymph node dissection, lower mediastinal lymph node dissection, abdominal para aortic lymph node dissection), rational selection of digestive tract reconstruction methods with anti-reflux effect, food storage capacity and the best quality of life, and safe anastomosis or suture technique of esophagojejunostomy.

     

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