CAJ | 학술논문

气管插管全麻，采用五孔法，常规探查，注意肝脏、腹腔及大网膜有无明显转移，定位明确肿瘤位置及是否侵及浆膜等。沿横结肠边缘超声刀游离横结肠系膜前叶，向右游离至结肠肝曲，左至脾曲，离短网膜左血管，清扫4sb，4d淋巴结。沿结肠中动脉及其分支分离，向上暴露肠系膜上静脉、右结肠静脉，胃网膜右静脉。骨骼化胃网膜右动脉于根部切断，裸化十二指肠下缘。清扫胰腺前被膜，暴露胃十二指肠动脉，肝总动脉、胃左、脾动脉和腹腔干，切断胃左动脉清扫第7．8．9．11 p组淋巴结。向下剥离、裸化肝十二指肠韧带，清扫第12a组淋巴结，并向上彻底清扫第1，3，5组淋巴结。使用内镜下直线切割吻合器离断十二指肠球部，胃体，行胃大弯和十二指肠后壁三角吻合。扩大脐部穿刺孔至3 cm，取出标本后缝合切口。
기관삽관전마，채용오공법，상규탐사，주의간장、복강급대망막유무명현전이，정위명학종류위치급시부침급장막등。연횡결장변연초성도유리횡결장계막전협，향우유리지결장간곡，좌지비곡，리단망막좌혈관，청소4sb，4d림파결。연결장중동맥급기분지분리，향상폭로장계막상정맥、우결장정맥，위망막우정맥。골격화위망막우동맥우근부절단，라화십이지장하연。청소이선전피막，폭로위십이지장동맥，간총동맥、위좌、비동맥화복강간，절단위좌동맥청소제7．8．9．11 p조림파결。향하박리、라화간십이지장인대，청소제12a조림파결，병향상철저청소제1，3，5조림파결。사용내경하직선절할문합기리단십이지장구부，위체，행위대만화십이지장후벽삼각문합。확대제부천자공지3 cm，취출표본후봉합절구。
Tracheal Intubation using the five-hole method was performed under general anesthesia to explore the liver, abdominal cavity and the larger omentum so as to confirm the tumor location and the involvement of the serosa membrane.An ultrasonic scalpel was used along the edge of the tranverse colon to dissect the anterior lobe of the mesocolon, moving right towards the hepatic flexure and left towards the splenic flexure.By dissecting the left gastroepiploic vessel, the 4sb,4d group lymph nodes were resected. Along the median colon arteries upwards the superior mesenteric vein, right colonic vein, right gastroepiploic vein, the right gatsroepiploic vein was skeletonized and No 6 group lymph nodes were resected to expose the lower margin duodenum.The anterior capsule of the pancreas was resected to expose the gastroduodenal artery.And after that along the gastrodudenal artery to dissect common hepatic artery, left stomach artery, splenic artery and the celiac trunk, the left gastric artery was sleketonized to resect 7, 8, 9 and 11p groups of lymph nodes.Stripping down towards the hepatoduodenal ligament, and to resect 12a group of lymph nodes, and to dissect hepatogastric ligament and to remove 1, 3, 5p groups of lymph nodes.An endoscopic linear cutting anastomat was used to divide duodenal bulb and gastric body.