腹腔镜胃癌根治术适应证及镜下解剖

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title,*,单击此处编辑母版标题样式,单击此处编辑母版文本样式,第二级,第三级,第四级,第五级,*,*,Click to edit Master title style,Click to edit Master text styles,Second level,Third level,Fourth level,Fifth level,*,1.,腹腔镜胃癌根治术适应证,2.,腹腔镜胃癌根治术镜下解剖,Contents,胃肿瘤浸润深度在,T2,以内者,;,胃恶性间质瘤、淋巴瘤等其他恶性肿瘤,;,胃癌的探查及分期,;,晚期胃癌的短路手术,;,胃癌术前、术中分期检查考虑为,、,、,a,期者。,腹腔镜胃癌根治术适应证,(1),已被认可的腹腔镜胃癌手术适应证,:,肿瘤侵及浆膜层,但浆膜受侵面积,10 cm,或淋巴结转移灶融合并包绕重要血管和,/,或肿瘤与,周围组织广泛浸润者。,(2),腹部严重粘连、重度肥胖、胃癌急症手术和心、,肺功能不良者为相对禁忌,;,全身情况不良,虽经术前,治疗仍不能纠正者,;,有严重心、肺、肝、肾疾患,不,能耐受手术者。,腹腔镜胃癌根治术,禁忌证,腹腔镜胃癌手术自,1994,年日本,Kitano,等首次报道,据日本内镜外科协会调查结果显示,到,2003,年为止，,日本共有,7800,例胃癌患者采取腹腔镜胃癌手术,。,腹腔镜胃癌根治术,手术现状,近年来,国内、外腹腔镜胃癌手术开展单位及报道例,数逐渐增多，取得了较大的进展,是目前临床探索研,究的热点问题。,腹腔镜胃癌根治术,手术现状,腹腔镜胃癌根治术,2009,年,9,月至,2011,年,6,月我们应用腹腔镜技术,开展,22,例胃癌及,67,例结直肠癌手术。,手术时间胃癌，结直肠癌。,腹腔镜胃肠肿瘤手术,工作进展,腹腔镜胃癌例数,平均年龄,男性,女性,总计,61.5,（,46-75,）,19,（,86%,）,3,（,14%,）,22,开腹胃癌手术,腹腔镜胃癌手术,腹腔镜胃癌根治术,离断胃结肠韧带,胃结肠韧带,处理胃网膜左血管,处理胃网膜右血管,离断胃右血管,处理胃左血管,离断肝胃韧带,镜下断十二指肠,体外吻合,1.,随着人们健康意识的提高和医生技术水平的提高，早,期胃肠肿瘤诊断率不断提高。,2.,微创腔镜技术在中、早期胃肠道肿瘤手术方面显示出,术野清楚、淋巴清扫完全、创伤小的优势。,3.,腹腔镜器械的不断完善，包括超声刀的应用，使腹腔,镜技术在胃肠肿瘤手术的应用成为普及的可能。,4.,手术医生的态度是掌握完成腹腔镜胃肠肿瘤手术的关,键；患者利益高于一切！,腹腔镜胃癌根治术,关于腹腔镜手术与开腹手术的认识,1.,能否进行腹腔镜胃肠肿瘤手术，关键因素决定于肿,瘤的病期。,2.,腹腔镜胃肠肿瘤手术第一目的即是探查；进一步确,诊，进一步肿瘤分期。,3.,晚期肿瘤转开腹及术中意外转开腹体现手术医生的,手术策略思想。,4.,术前患者谈话明确腹腔镜手术或开腹手术仅是手术,方式，完成根治手术才是目的，由此给手术医生留下,中转手术的空间。,腹腔镜胃癌根治术,关于腹腔镜手术与开腹手术的认识,Thank You !,Thank You !,不尽之处，恳请指正！,