博朗剃须刀ct3清洗多久,腹腔镜胃癌手术操作指南（2023版）

腹腔镜胃癌手术操作指南（2023版）

作者：中华医学会外科学分会腹腔镜与内镜外科学组,中国研究型医院学会机器人与腹腔镜外科专业委员会,中国抗癌协会腔镜与机器人外科分会,中国医学装备协会腔镜与微创技术分会
文章来源：中华消化外科杂志, 2023, 22(4)

摘要

以腹腔镜技术为代表的微创外科技术是目前胃癌外科治疗的重要手段。随着近年越来越多高质量临床研究的开展和结果公布，腹腔镜技术在胃癌手术治疗的适应证得到了更多的循证医学支持，并在新辅助治疗患者、晚期胃癌转化治疗患者等多个方面进行了积极探索。此外，腹腔镜胃癌外科亦在淋巴结清扫及手术切除范围、全腹腔镜手术、保留幽门的胃切除、近端胃切除的消化道重建、淋巴结示踪等多方面具有较大进展。基于《腹腔镜胃癌手术操作指南（2016版）》，结合近年研究热点及高等级循证医学成果，以临床证据为基础，以临床问题为导向，再次修订更新形成《腹腔镜胃癌手术操作指南（2023版）》。

以腹腔镜技术为代表的微创外科技术是目前胃癌外科治疗的重要手段。《腹腔镜胃癌手术操作指南（2007版）》于2007年首次发表，有力推动了我国腹腔镜胃癌根治手术的技术普及与发展。随着腹腔镜相关器械设备与手术技术的不断发展与进步，2016年中华医学会外科学分会腹腔镜与内镜外科学组和中国研究型医院学会机器人与腹腔镜外科专业委员会组织相关专家，对手术适应证、手术入路、淋巴结清扫范围及消化道重建方面内容进行更新，进一步规范腹腔镜技术在胃癌根治手术中的应用。近年来，国内外特别是我国在腹腔镜胃癌根治术的手术技术和循证医学方面均有巨大发展，高质量临床研究相继开展，相关证据陆续发表。为顺应学科发展与临床实践的需求，中华医学会外科学分会腹腔镜与内镜外科学组联合国内相关学术组织，组织国内相关领域专家，就腹腔镜胃癌根治术的适应证与禁忌证、手术设备与器械选择、手术基本原则及手术方式等方面，以临床证据为基础、临床问题为导向，再次修订更新形成《腹腔镜胃癌手术操作指南（2023版）》（以下简称指南）。

一、腹腔镜手术适应证

（一）腹腔镜早期胃癌手术适应证

（二）腹腔镜局部进展期胃癌手术适应证

二、腹腔镜胃癌手术方式与种类

（一）手术方式

1.全腹腔镜胃癌根治术：胃切除、淋巴结清扫、消化道重建均在腹腔镜下完成，技术要求较高［32, 33, 34, 35, 36］。

2.小切口辅助腹腔镜胃癌根治术：又称腹腔镜辅助手术，胃游离、淋巴结清扫在腹腔镜下完成，胃切除或消化道重建经腹壁小切口辅助完成，是目前应用最多的手术方式。

（二）手术种类

三、腹腔镜胃癌手术根治切除范围

腹腔镜胃癌根治手术的切除范围遵循开腹手术的原则：

（一）安全切缘

（二）手术方式选择

早期胃癌术后长期预后相对较好，选择消化道重建方式时应考虑患者术后的生命质量和残胃的功能保留。PPG适用于临床分期为cT1N0M0期的胃中段癌，目前已有相关荟萃分析结果显示：PPG相比远端胃切除术，远期预后无明显差异，但淋巴结清扫数目及切缘距离均显著劣于远端胃切除术［42］。韩国KLASS-04研究对比分析腹腔镜PPG和腹腔镜远端胃切除术，其已公布的短期结果显示：两者术后并发症发生率无显著差异［43］。后续有待长期生存结果公布。

（三）胃周淋巴结清扫范围

应按胃癌分期方法的规定清扫淋巴结。（1）腹腔镜胃癌D1淋巴结清扫术：清扫胃周第1站淋巴结。（2）腹腔镜胃癌D1+淋巴结清扫术：清扫第1站及部分第2站淋巴结。（3）腹腔镜胃癌D2淋巴结清扫术：清扫胃周第2站淋巴结。原则上前2种淋巴结清扫范围主要适用于早期胃癌、无淋巴结转移者，或因高龄、全身伴发疾病不能忍受长时间手术者。对伴淋巴结转移的早期胃癌和局部进展期胃癌，原则上应行D2淋巴结清扫术。

不同部位胃癌淋巴结清扫范围参考《日本胃癌治疗指南（第6版）》。（1）全胃切除：D0，清扫范围小于D1；D1，清扫第1~7组淋巴结；D1+，D1清扫+第8a、9、11p组淋巴结；D2，D1清扫+第8a、9、11p、11d、12a组淋巴结。（2）远端胃大部切除：D0，清扫范围小于D1；D1，清扫第1、3、4sb、4d、5、6、7组淋巴结；D1+，D1清扫+第8a、9组淋巴结；D2，D1清扫+第8a、9、11p、12a组淋巴结。（3）保留幽门的胃大部切除：D0，清扫范围小于D1；D1，清扫第1、3、4sb、4d、6、7组淋巴结，即使第6i组淋巴结不完全清扫仍视为D1；D1+，D1清扫+第8a、9组淋巴结。（4）近端胃大部切除：D0，清扫范围小于D1；D1，清扫第1、2、3a、4sa、4sb、7组淋巴结；D1+，D1清扫+第8a、9、11p组淋巴结；D2，D1清扫+第8a、9、11p、11d组淋巴结。

对于初始可切除的胃癌，术中是否行网膜囊切除（胰腺包膜及横结肠系膜前叶切除），1项大型RCT（JCOG1001）结果显示：保留网膜囊与联合网膜囊切除胃癌患者5年生存结果相似，网膜囊切除并未带来显著生存获益，且术后胰瘘发生率显著增加［45］。因此，目前不建议联合网膜囊切除。

四、腹腔镜胃癌手术消化道重建

（一）腹腔镜远端胃切除的消化道重建

（二）腹腔镜全胃切除术的消化道重建

（三）腹腔镜近端胃切除术的消化道重建

目前，腹腔镜近端胃切除的消化道重建手术方式较多，各有优劣，且尚缺乏直接对比不同手术方式的临床研究，应根据患者肿瘤情况、组织解剖特点、术者自身习惯等多方面因素选择合适的重建方式。

五、腹腔镜胃癌手术肿瘤定位

已有较多相关研究结果显示：可通过术前放置钛夹、内镜下注射纳米碳、吲哚菁绿等示踪剂以及术中胃镜等多种方式协助定位，且均能达到较高的符合率［92, 93, 94, 95, 96, 97, 98］。其中，术中胃镜定位对于切缘的精准定位相比示踪剂更具有优势，而纳米碳及吲哚菁绿注射法在定位肿瘤的同时，对于术中淋巴结清扫存在优势［95, 96］。

六、腹腔镜胃癌手术设备与器械

1项RCT结果显示：3D腹腔镜胃癌根治术在手术时间上非劣效于2D腹腔镜胃癌根治术，能显著减少术中出血量，且3D腹腔镜对胃癌术中大出血（>200 mL）是独立保护因素［99］。另1项针对胃肠肿瘤手术的1 456例大宗荟萃分析结果同样显示：3D腹腔镜较2D腹腔镜在胃癌根治术中有缩短手术时间和减少术中出血量的优势［100］。此外，其他相关研究结果也显示：3D腹腔镜优势包括（1）缩短胃癌根治术手术时间，主要体现在缩短淋巴结清扫时间、腹腔镜下缝合时间等方面［101, 102］。（2）增加淋巴结清扫总数目，特别是第8a、11p组淋巴结数目［103, 104, 105］。（3）降低术后并发症发生率［106, 107］。但对于此类优势尚缺乏高等级证据支持。

目前腹腔镜胃癌手术的常用操作器械包括电能量器械及超声能量器械，电能量器械中又包括单极电能量器械及双极电能量器械如（Ligasure等）。单极电能量器械可对直径<2 mm的血管直接止血。双极电能量器械如Ligasure最高可实现<7 mm血管的凝固止血，故对肥胖、组织质地差、新辅助和转化治疗后患者具有优势［115, 116, 117, 118］。超声能量器械可对直径≤5 mm的血管进行有效凝固止血，同时可完成组织的切割、分离、抓持等操作。

《腹腔镜胃癌手术操作指南（2023版）》编审委员会成员名单（按姓氏汉语拼音排序）
曹 晖 上海交通大学医学院附属仁济医院

陈 凛 解放军总医院第一医学中心

程向东 中国科学院大学附属肿瘤医院

董 明 中国医科大学附属第一医院

樊 林 西安交通大学第一附属医院

巩 鹏 深圳大学总医院

何显力 空军军医大学第二附属医院

胡 祥 大连医科大学附属第一医院

胡三元 山东第一医科大学第一附属医院山东省千佛山医院

胡建昆 四川大学华西医院

胡伟国 上海交通大学医学院附属瑞金医院

胡文庆 长治市人民医院

黄昌明 福建医科大学附属协和医院

黄 华 复旦大学附属肿瘤医院

季加孚 北京大学肿瘤医院

靖昌庆 山东省立医院

柯重伟 复旦大学附属上海市第五人民医院

李国新 南方医科大学南方医院

李 勇 广东省人民医院

李子禹 北京大学肿瘤医院

连长红 长治医学院附属和平医院

刘凤林 复旦大学附属中山医院

马君俊 上海交通大学医学院附属瑞金医院

仇 明 海军军医大学第二附属医院（上海长征医院）

孙 晶 上海交通大学医学院附属瑞金医院

孙益红 复旦大学附属中山医院

所 剑 吉林大学第一医院

汪 勇 浙江大学医学院附属邵逸夫医院

王 琛 兰州大学第二医院

王 权 吉林大学第一医院

王 伟 广东省中医院

王旭东 吉林大学第二医院

徐泽宽 南京医科大学第一附属医院

燕 速 青海大学附属医院

杨盈赤 首都医科大学附属北京友谊医院

姚琪远 复旦大学附属华山医院

应敏刚 福建医科大学附属厦门弘爱医院

尤 俊 厦门大学附属第一医院

于文滨 山东大学齐鲁医院

余佩武 陆军军医大学第一附属医院

余 江 南方医科大学南方医院

臧 潞 上海交通大学医学院附属瑞金医院

赵永亮 陆军军医大学第一附属医院

张忠涛 首都医科大学附属北京友谊医院

张光永 山东第一医科大学第一附属医院山东省千佛山医院

郑民华 上海交通大学医学院附属瑞金医院

郑朝辉 福建医科大学附属协和医院

周建平 中国医科大学附属第一医院

朱甲明 中国医科大学附属第一医院

宗雅萍 上海交通大学医学院附属瑞金医院

执笔者：

臧 潞 上海交通大学医学院附属瑞金医院

马君俊 上海交通大学医学院附属瑞金医院

赵永亮 陆军军医大学第一附属医院

赵 轩 上海交通大学医学院附属瑞金医院

张鲁阳 上海交通大学医学院附属瑞金医院

参考文献

[1]

KimHH, HanSU, KimMC, et al. Effect of laparoscopic distal gastrectomy vs open distal gastrectomy on long-term survival among patients with stage Ⅰ gastric cancer: the KLASS-01 randomized clinical trial[J]. JAMA Oncol, 2019, 5(4):506-513. DOI: 10.1001/jamaoncol.2018.6727.

[2]

KimW, KimHH, HanSU, et al. Decreased morbidity of lapa-roscopic distal gastrectomy compared with open distal gastrectomy for stage Ⅰ gastric cancer: short-term outcomes from a multicenter randomized controlled trial (KLASS-01)[J]. Ann Surg, 2016, 263(1):28-35. DOI: 10.1097/SLA.0000000000001346.

[3]

KataiH, MizusawaJ, KatayamaH, et al. Survival outcomes after laparoscopy-assisted distal gastrectomy versus open distal gastrectomy with nodal dissection for clinical stage ⅠA or ⅠB gastric cancer (JCOG0912): a multicentre, non-inferiority, phase 3 randomised controlled trial[J]. Lancet Gastroenterol Hepatol, 2020, 5(2):142-151. DOI: 10.1016/S2468-1253(19)30332-2.

[4]

KataiH, SasakoM, FukudaH, et al. JCOG Gastric Cancer Surgical Study Group. Safety and feasibility of laparoscopy-assisted distal gastrectomy with suprapancreatic nodal dissection for clinical stage I gastric cancer: a multicenter phase Ⅱ trial (JCOG 0703) [J]. Gastric Cancer, 2010, 13(4):238-244. DOI: 10.1007/s10120-010-0565-0.

[5]

胡祥. 第6版日本《胃癌治疗指南》拔萃[J].中国实用外科杂志, 2021, 41(10):1130-1141. DOI: 10.19538/j.cjps.issn1005-2208.2021.10.07.

[6]

KataiH, MizusawaJ, KatayamaH, et al. Single-arm confirmatory trial of laparoscopy-assisted total or proximal gastrectomy with nodal dissection for clinical stage Ⅰ gastric cancer: Japan Clinical Oncology Group study JCOG1401[J]. Gastric Cancer, 2019, 22(5):999-1008. DOI: 10.1007/s10120-019-00929-9.

[7]

HyungWJ, YangHK, HanSU, et al. A feasibility study of laparoscopic total gastrectomy for clinical stage Ⅰ gastric cancer: a prospective multi-center phase Ⅱ clinical trial, KLASS 03[J]. Gastric Cancer, 2019, 22(1):214-222. DOI: 10.1007/s10120-018-0864-4.

[8]

LiuF, HuangC, XuZ, et al. Morbidity and mortality of laparoscopic vs open total gastrectomy for clinical stage Ⅰ gastric cancer: the CLASS02 multicenter randomized clinical trial[J]. JAMA Oncol, 2020, 6(10):1590-1597. DOI: 10.1001/jamaoncol.2020.3152.

[9]

HyungWJ, YangHK, ParkYK, et al. Long-term outcomes of laparoscopic distal gastrectomy for locally advanced gastric cancer: the KLASS-02-RCT randomized clinical trial[J]. J Clin Oncol, 2020, 38(28):3304-3313. DOI: 10.1200/JCO.20.01210.

[10]

HuangC, LiuH, HuY, et al. Laparoscopic vs open distal gastrectomy for locally advanced gastric cancer: five-year outcomes from the CLASS-01 randomized clinical trial[J]. JAMA Surg, 2022, 157(1):9-17. DOI: 10.1001/jamasurg.2021.5104.

[11]

HuY, HuangC, SunY, et al. Morbidity and mortality of lapa-roscopic versus open D2 distal gastrectomy for advanced gastric cancer: a randomized controlled trial[J]. J Clin Oncol, 2016, 34(12):1350-1357. DOI: 10.1200/JCO.2015.63.7215.

[12]

WuSY, HoMH, ChangHM, et al. Long-term oncologic result of laparoscopic versus open gastrectomy for gastric cancer: a propensity score matching analysis[J]. World J Surg Oncol, 2021, 19(1):101. DOI: 10.1186/s12957-021-02217-2.

[13]

ChanB, YauK, ChanC. Totally laparoscopic versus open gastrectomy for advanced gastric cancer: a matched retrospective cohort study[J]. Hong Kong Med J, 2019, 25(1):30-37. DOI: 10.12809/hkmj177150.

[14]

陈豪, 余佩武, 黄昌明, 等. 腹腔镜远端胃癌D2根治术治疗局部进展期胃癌10年预后及影响因素分析:基于CLASS队列的全国多中心研究[J].中华消化外科杂志, 2022, 21(3):362-374. DOI: 10.3760/cma.j.cn115610-20220221-00100.

[15]

InakiN, EtohT, OhyamaT, et al. A multi-institutional, prospective, phase Ⅱ feasibility study of laparoscopy-assis-ted distal gastrectomy with D2 lymph node dissection for locally advanced gastric cancer (JLSSG0901)[J]. World J Surg, 2015, 39(11):2734-2741. DOI: 10.1007/s00268-015-3160-z.

[16]

所为然. JLSSG0901研究结果简介[J].中国实用外科杂志, 2022, 42(8):885-886,889. DOI: 10.19538/j.cjps.issn1005-2208.2022.08.07.

[17]

van der VeenA, BrenkmanH, SeesingM, et al. Laparos-copic versus open gastrectomy for gastric cancer (LOGICA): a multicenter randomized clinical trial[J]. J Clin Oncol, 2021, 39(9):978-989. DOI: 10.1200/JCO.20.01540.

[18]

[19]

XingJ, WangY, ShanF, et al. Comparison of totally laparoscopic and laparoscopic assisted gastrectomy after neoadjuvant chemotherapy in locally advanced gastric cancer[J]. Eur J Surg Oncol, 2021, 47(8):2023-2030. DOI: 10.1016/j.ejso.2021.02.002.

[20]

van der WielenN, StraatmanJ, DaamsF, et al. Open versus minimally invasive total gastrectomy after neoadjuvant chemotherapy: results of a European randomized trial[J]. Gastric Cancer, 2021, 24(1):258-271. DOI: 10.1007/s10120-020-01109-w.

[21]

WangN, ZhouA, JinJ, et al. Open vs. laparoscopic surgery for locally advanced gastric cancer after neoadjuvant therapy: short-term and long-term survival outcomes[J]. Oncol Lett, 2020, 20(1):861-867. DOI: 10.3892/ol.2020.11626.

[22]

FujisakiM, MitsumoriN, ShinoharaT, et al. Short- and long-term outcomes of laparoscopic versus open gastrectomy for locally advanced gastric cancer following neoadjuvant chemotherapy[J]. Surg Endosc, 2021, 35(4):1682-1690. DOI: 10.1007/s00464-020-07552-1.

[23]

[24]

KhorobrykhTV, AbdulkhakimovNM, AgadzhanovVG, et al. Laparoscopic versus open surgery for locally advanced and metastatic gastric cancer complicated with bleeding and/or stenosis: short-and long-term outcomes[J]. World J Surg Oncol, 2022, 20(1):216. DOI: 10.1186/s12957-022-02674-3.

[25]

[26]

[27]

[28]

LiZ, GuanG, LiuZ, et al. Predicting peritoneal carcinomatosis of gastric cancer: a simple model to exempt low-risk patients from unnecessary staging laparoscopy[J]. Front Surg, 2022, 9:916001. DOI: 10.3389/fsurg.2022.916001.

[29]

GuanG, LiZ, WangQ, et al. Risk factors associated with peritoneal carcinomatosis of gastric cancer in staging laparoscopy: a systematic review and meta-analysis[J]. Front Oncol, 2022, 12:955181. DOI: 10.3389/fonc.2022.955181.

[30]

LiK, CannonJ, JiangSY, et al. Diagnostic staging laparoscopy in gastric cancer treatment: a cost-effectiveness ana-lysis[J]. J Surg Oncol, 2018, 117(6):1288-1296. DOI: 10.1002/jso.24942.

[31]

IrinoT, SanoT, HikiN, et al. Diagnostic staging laparoscopy in gastric cancer: a prospective cohort at a cancer institute in Japan[J]. Surg Endosc, 2018, 32(1):268-275. DOI: 10.1007/s00464-017-5673-z.

[32]

中华医学会外科学分会胃肠外科学组, 中华医学会外科学分会腹腔镜与内镜外科学组, 中国抗癌协会胃癌专业委员会. 完全腹腔镜胃癌手术消化道重建专家共识及手术操作指南(2018版)[J].中国实用外科杂志, 2018, 38(8):833-839. DOI: 10.19538/j.cjps.issn1005-2208.2018.08.01.

[33]

HanWH, OhYJ, EomBW, et al. A comparative study of the short-term operative outcome between intracorporeal and extracorporeal anastomoses during laparoscopic total gas-trectomy[J]. Surg Endosc, 2021, 35(4):1602-1609. DOI: 10.1007/s00464-020-07539-y.

[34]

GongCS, KimBS, KimHS. Comparison of totally laparos-copic total gastrectomy using an endoscopic linear stapler with laparoscopic-assisted total gastrectomy using a circular stapler in patients with gastric cancer: a single-center experience[J]. World J Gastroenterol, 2017, 23(48):8553-8561. DOI: 10.3748/wjg.v23.i48.8553.

[35]

ParkSH, SuhYS, KimTH, et al. Postoperative morbidity and quality of life between totally laparoscopic total gastrectomy and laparoscopy-assisted total gastrectomy: a propensity-score matched analysis[J]. BMC Cancer, 2021, 21(1):1016. DOI: 10.1186/s12885-021-08744-1.

[36]

[37]

ZhangP, ZhangX, XueH. Long-term results of hand-assisted laparoscopic gastrectomy for advanced Siewert type Ⅱ and type Ⅲ esophagogastric junction adenocarcinoma[J]. Int J Surg, 2018, 53:201-205. DOI: 10.1016/j.ijsu.2018.03.004.

[38]

HagiwaraK, MatsudaM, HayashiS, et al. Comparison of short-term outcomes between hand-assisted laparoscopic distal gastrectomy and laparoscopy-assisted distal gastrec-tomy in gastric cancer[J]. Surg Laparosc Endosc Percutan Tech, 2020, 30(3):249-256. DOI: 10.1097/SLE.0000000000000768.

[39]

Mikulicz-RadeckiJ. Die chirurgische behandlung des chronischen magengeschwurs[J]. Verhandl Deutsch Gessellsch Chir, 1897, 26:31.

[40]

WangensteenOH. Segmental gastric resection for peptic ulcer; method permitting restoration of anatomic continuity[J]. J Am Med Assoc, 1952, 149(1):18-23. DOI: 10.1001/jama.1952.02930180020005.

[41]

[42]

HouS, LiuF, GaoZ, et al. Pathological and oncological outcomes of pylorus-preserving versus conventional distal gastrectomy in early gastric cancer: a systematic review and meta-analysis[J]. World J Surg Oncol, 2022, 20(1):308. DOI: 10.1186/s12957-022-02766-0.

[43]

ParkDJ, KimYW, YangHK, et al. Short-term outcomes of a multicentre randomized clinical trial comparing laparoscopic pylorus-preserving gastrectomy with laparoscopic distal gastrectomy for gastric cancer (the KLASS-04 trial)[J]. Br J Surg, 2021, 108(9):1043-1049. DOI: 10.1093/bjs/znab295.

[44]

[45]

KurokawaY, DokiY, MizusawaJ, et al. Bursectomy versus omentectomy alone for resectable gastric cancer (JCOG1001): a phase 3, open-label, randomised controlled trial[J]. Lancet Gastroenterol Hepatol, 2018, 3(7):460-468. DOI: 10.1016/S2468-1253(18)30090-6.

[46]

ZhengC, XuY, ZhaoG, et al. Outcomes of laparoscopic total gastrectomy combined with spleen-preserving hilar lymphadenectomy for locally advanced proximal gastric cancer: a nonrandomized clinical trial[J]. JAMA Netw Open, 2021, 4(12):e2139992. DOI: 10.1001/jamanetworkopen.2021.39992.

[47]

SanoT, SasakoM, MizusawaJ, et al. Randomized contro-lled trial to evaluate splenectomy in total gastrectomy for proximal gastric carcinoma[J]. Ann Surg, 2017, 265(2):277-283. DOI: 10.1097/SLA.0000000000001814.

[48]

[49]

AoyagiK, KouhujiK, MiyagiM, et al. Prognosis of metastatic splenic hilum lymph node in patients with gastric cancer after total gastrectomy and splenectomy[J]. World J Hepatol, 2010, 2(2):81-86. DOI: 10.4254/wjh.v2.i2.81.

[50]

JeongO, JungMR, RyuSY. Clinicopathological features and prognostic impact of splenic hilar lymph node metastasis in proximal gastric carcinoma[J]. Eur J Surg Oncol, 2019, 45(3):432-438. DOI: 10.1016/j.ejso.2018.10.531.

[51]

[52]

黄昌明, 林密. 腹腔镜下脾门淋巴结清扫的技术要点——镜下脾门淋巴结清研究设计的初衷[J].中华胃肠外科杂志, 2018, 21(2):143-147. DOI: 10.3760/cma.j.issn.1671-0274.2018.02.005.

[53]

KinoshitaT, OkayamaT. Is splenic hilar lymph node dissection necessary for proximal gastric cancer surgery?[J]. Ann Gastroenterol Surg, 2021, 5(2):173-182. DOI: 10.1002/ags3.12413.

[54]

KanayaS, GomiT, MomoiH, et al. Delta-shaped anastomosis in totally laparoscopic Billroth Ⅰ gastrectomy: new technique of intraabdominal gastroduodenostomy[J]. J Am Coll Surg, 2002, 195(2):284-287. DOI: 10.1016/s1072-7515(02)01239-5.

[55]

[56]

苗儒林, 李子禹, 陕飞, 等. 全腹腔镜远端胃切除Overlap法Billroth Ⅰ式消化道重建探讨(附1例报告)[J].中国实用外科杂志, 2017, 37(1):93-95. DOI: 10.19538/j.cjps.issn1005-2208.2017.01.26.

[57]

[58]

YalikunA, AikemuB, LiS, et al. A modified Billroth-Ⅱ with braun anastomosis in totally laparoscopic distal gastrectomy: initial experience compared with Roux-en-Y anastomosis[J]. Ann Surg Oncol, 2022, 29(4):2359-2367. DOI: 10.1245/s10434-021-11187-4.

[59]

[60]

[61]

[62]

WangJ, WangQ, DongJ, et al. Total laparoscopic uncut Roux-en-Y for radical distal gastrectomy: an interim analy-sis of a randomized, controlled, clinical trial[J]. Ann Surg Oncol, 2021, 28(1):90-96. DOI: 10.1245/s10434-020-08710-4.

[63]

ZhaoS, ZhengK, ZhengJC, et al. Comparison of totally lapa-roscopic total gastrectomy and laparoscopic-assisted total gastrectomy: a systematic review and meta-analysis[J]. Int J Surg, 2019, 68:1-10. DOI: 10.1016/j.ijsu.2019.05.020.

[64]

MiloneM, ManigrassoM, BuratiM, et al. Intracorporeal versus extracorporeal anastomosis after laparoscopic gastrectomy for gastric cancer. A systematic review with meta-analysis[J]. J Visc Surg, 2019, 156(4):305-318. DOI: 10.1016/j.jviscsurg.2019.01.004.

[65]

ZhengXY, PanY, ChenK, et al. Comparison of intracorporeal and extracorporeal esophagojejunostomy after laparoscopic total gastrectomy for gastric cancer: a meta-analy-sis based on short-term outcomes[J]. Chin Med J (Engl), 2018, 131(6):713-720. DOI: 10.4103/0366-6999.226899.

[66]

UsuiS, NagaiK, HiranumaS, et al. Laparoscopy-assisted esophagoenteral anastomosis using endoscopic purse-string suture instrument “Endo-PSI (II)” and circular stapler[J]. Gastric Cancer, 2008, 11(4):233-237. DOI: 10.1007/s10120-008-0481-8.

[67]

JeongO, ParkYK. Intracorporeal circular stapling esopha-gojejunostomy using the transorally inserted anvil (OrVil) after laparoscopic total gastrectomy[J]. Surg Endosc, 2009, 23(11):2624-2630. DOI: 10.1007/s00464-009-0461-z.

[68]

OmoriT, OyamaT, MizutaniS, et al. A simple and safe technique for esophagojejunostomy using the hemidouble stapling technique in laparoscopy-assisted total gastrectomy[J]. Am J Surg, 2009, 197(1):e13-e17. DOI: 10.1016/j.amjsurg.2008.04.019.

[69]

UmemuraA, KoedaK, SasakiA, et al. Totally laparoscopic total gastrectomy for gastric cancer: literature review and comparison of the procedure of esophagojejunostomy[J]. Asian J Surg, 2015, 38(2):102-112. DOI: 10.1016/j.asjsur.2014.09.006.

[70]

[71]

YangHK, HyungWJ, HanSU, et al. Comparison of surgical outcomes among different methods of esophagojejunostomy in laparoscopic total gastrectomy for clinical stage Ⅰproximal gastric cancer: results of a single-arm multicenter phase Ⅱ clinical trial in Korea, KLASS 03[J]. Surg Endosc, 2021, 35(3):1156-1163. DOI: 10.1007/s00464-020-07480-0.

[72]

GuoZ, DengC, ZhangZ, et al. Safety and effectiveness of overlap esophagojejunostomy in totally laparoscopic total gastrectomy for gastric cancer: a systematic review and meta-analysis[J]. Int J Surg, 2022, 102:106684. DOI: 10.1016/j.ijsu.2022.106684.

[73]

UyamaI, SugiokaA, FujitaJ, et al. Laparoscopic total gastrectomy with distal pancreatosplenectomy and D2 lymph-adenectomy for advanced gastric cancer[J]. Gastric Cancer, 1999, 2(4):230-234. DOI: 10.1007/s101200050069.

[74]

KwonIG, SonYG, RyuSW. Novel intracorporeal esophagojejunostomy using linear staplers during laparoscopic total gastrectomy: π-shaped esophagojejunostomy, 3-in-1 technique[J]. J Am Coll Surg, 2016, 223(3):e25-e29. DOI: 10.1016/j.jamcollsurg.2016.06.011.

[75]

InabaK, SatohS, IshidaY, et al. Overlap method: novel intracorporeal esophagojejunostomy after laparoscopic total gastrectomy[J]. J Am Coll Surg, 2010, 211(6):e25-e29. DOI: 10.1016/j.jamcollsurg.2010.09.005.

[76]

韦明光, 王楠, 吴涛, 等. 食管空肠overlap与π形吻合术后短期疗效及患者生活质量的对比研究[J].中国普通外科杂志, 2019, 28(4):407-416. DOI: 10.7659/j.issn.1005-6947.2019.04.005.

[77]

[78]

KyogokuN, EbiharaY, ShichinoheT, et al. Circular versus linear stapling in esophagojejunostomy after laparoscopic total gastrectomy for gastric cancer: a propensity score-matched study[J]. Langenbecks Arch Surg, 2018, 403(4):463-471. DOI: 10.1007/s00423-018-1678-x.

[79]

[80]

AhnSH, LeeJH, ParkDJ, et al. Comparative study of clinical outcomes between laparoscopy-assisted proximal gastrectomy (LAPG) and laparoscopy-assisted total gastrectomy (LATG) for proximal gastric cancer[J]. Gastric Cancer, 2013, 16(3):282-289. DOI: 10.1007/s10120-012-0178-x.

[81]

[82]

[83]

YamashitaY, TatsubayashiT, OkumuraK, et al. Modified side overlap esophagogastrostomy after laparoscopic proxi-mal gastrectomy[J]. Ann Gastroenterol Surg, 2022, 6(4):594-599. DOI: 10.1002/ags3.12549.

[84]

KurodaS, NishizakiM, KikuchiS, et al. Double-flap technique as an antireflux procedure in esophagogastrostomy after proximal gastrectomy[J]. J Am Coll Surg, 2016, 223(2):e7-e13. DOI: 10.1016/j.jamcollsurg.2016.04.041.

[85]

KurodaS, ChodaY, OtsukaS, et al. Multicenter retrospective study to evaluate the efficacy and safety of the double-flap technique as antireflux esophagogastrostomy after proximal gastrectomy (rD-FLAP Study)[J]. Ann Gastroenterol Surg, 2019, 3(1):96-103. DOI: 10.1002/ags3.12216.

[86]

KataiH, MoritaS, SakaM, et al. Long-term outcome after proximal gastrectomy with jejunal interposition for suspected early cancer in the upper third of the stomach[J]. Br J Surg, 2010, 97(4):558-562. DOI: 10.1002/bjs.6944.

[87]

NomuraE, IsozakiH, FujiiK, et al. Postoperative evaluation of function-preserving gastrectomy for early gastric cancer[J]. Hepatogastroenterology, 2003, 50(54):2246-2250.

[88]

[89]

[90]

[91]

[92]

殷桂香, 杨峥, 刘彬彬, 等. 双镜联合治疗胃肠肿瘤的疗效分析[J].中华普通外科杂志, 2019, 34(4):368-369. DOI: 10.3760/cma.j.issn.1007-631X.2019.04.024.

[93]

倪红谚, 贾王强, 王晓明, 等. 术前瘤体钛夹定位对腹腔镜下胃癌术式选择的影响[J].中华普通外科杂志, 2021, 36(11):864-866. DOI: 10.3760/cma.j.cn113855-20210317-00170.

[94]

文阳, 钱振渊, 黄伟, 等. 钛夹标记联合CT图像后处理技术在早期胃癌腹腔镜术前定位中的应用[J].医学影像学杂志, 2021, 31(2):285-288.

[95]

[96]

李颖, 叶琳, 陈志冰. 吲哚菁绿(ICG)荧光成像在腹腔镜胃癌根治术中的应用价值研究[J].江西医药, 2021, 56(7):1023-1025. DOI: 10.3969/j.issn.1006-2238.2021.07.042.

[97]

[98]

Lucas Willian Thornblade, Kurt Allan Melstrom, ZhumkhawalaAli,等. 荧光显像技术在消化外科中的应用进展[J].中华消化外科杂志, 2021, 20(2):149-154. DOI: 10.3760/cma.j.cn115610-20201126-00740.

[99]

ZhengCH, LuJ, ZhengHL, et al. Comparison of 3D laparos-copic gastrectomy with a 2D procedure for gastric cancer: a phase 3 randomized controlled trial[J]. Surgery, 2018, 163(2):300-304. DOI: 10.1016/j.surg.2017.09.053.

[100]

ZhaoB, LvW, MeiD, et al. Comparison of short-term surgical outcome between 3D and 2D laparoscopy surgery for gastrointestinal cancer: a systematic review and meta-ana-lysis[J]. Langenbecks Arch Surg, 2020, 405(1):1-12. DOI: 10.1007/s00423-020-01853-8.

[101]

KanajiS, SuzukiS, HaradaH, et al. Comparison of two- and three-dimensional display for performance of laparoscopic total gastrectomy for gastric cancer[J]. Langenbecks Arch Surg, 2017, 402(3):493-500. DOI: 10.1007/s00423-017-1574-9.

[102]

LeeY, LeeCM, JangYJ, et al. Comparison of short-term out-comes using three-dimensional and two-dimensional lapa-roscopic gastrectomy for gastric cancer[J]. J Laparoendosc Adv Surg Tech A, 2019, 29(7):886-890. DOI: 10.1089/lap.2018.0765.

[103]

张珂诚, 王鑫鑫, 卫勃, 等. 3D与2D腹腔镜胃癌根治术近期疗效对比研究[J].中国实用外科杂志, 2017, 37(4):437-439. DOI: 10.19538/j.cjps.issn1005-2208.2017.04.29.

[104]

郑逸锋, 李威, 王怀明, 等. 3D腹腔镜与2D腹腔镜胃癌根治术短期临床疗效对比研究[J/CD].消化肿瘤杂志:电子版, 2017, 9(1):31-34.

[105]

LiuJ, ZhouH, QinH, et al. Comparative study of clinical efficacy using three-dimensional and two-dimensional laparoscopies in the treatment of distal gastric cancer[J]. Onco Targets Ther, 2018, 11:301-306. DOI: 10.2147/OTT.S153520.

[106]

李家新, 缪刚刚, 毛须平. 3D腹腔镜在腹腔镜辅助胃癌根治术中的应用价值[J].中国微创外科杂志, 2018, 18(12):1099-1102. DOI: 10.3969/j.issn.1009-6604.2018.12.012.

[107]

[108]

[109]

AbdelrahmanM, BelrammanA, SalemR, et al. Acquiring basic and advanced laparoscopic skills in novices using two-dimensional (2D), three-dimensional (3D) and ultra-high definition (4K) vision systems: a randomized control study[J]. Int J Surg, 2018, 53:333-338. DOI: 10.1016/j.ijsu.2018.03.080.

[110]

[111]

李树春, 臧潞, 郑民华. 微创智能化诊断与治疗技术在胃癌中的应用[J].中华消化外科杂志, 2021, 20(5):492-496. DOI: 10.3760/cma.j.cn115610-20210407-00172.

[112]

ChenQY, XieJW, ZhongQ, et al. Safety and efficacy of indocyanine green tracer-guided lymph node dissection during laparoscopic radical gastrectomy in patients with gastric cancer: a randomized clinical trial[J]. JAMA Surg, 2020, 155(4):300-311. DOI: 10.1001/jamasurg.2019.6033.

[113]

[114]

LuX, LiuS, XiaX, et al. The short-term and long-term outcomes of indocyanine green tracer-guided laparoscopic radical gastrectomy in patients with gastric cancer[J]. World J Surg Oncol, 19(1):271. DOI: 10.1186/s12957-021-02385-1.

[115]

NewcombWL, HopeWW, SchmelzerTM, et al. Comparison of blood vessel sealing among new electrosurgical and ultrasonic devices[J]. Surg Endosc, 2009, 23(1):90-96. DOI: 10.1007/s00464-008-9932-x.

[116]

OkhunovZ, YoonR, LuschA, et al. Evaluation and comparison of contemporary energy-based surgical vessel sealing devices[J]. J Endourol, 2018, 32(4):329-337. DOI: 10.1089/end.2017.0596.

[117]

[118]

平台合作联系方式

电话：010-51322382

邮箱：cmasurgery@163.com

欢迎关注普外空间微信矩阵

普外空间订阅号

普外空间CLUB服务号

普外空间视频号

普外空间小助手