CLEAR柯丽尔每日一例:全内脏反位腹腔镜胃癌根治术

2022-09-06 放射沙龙 中国医学论坛报

全内脏反位腹腔镜胃癌根治术病例分析。

近日,广东省人民医院普通外科一区胃肠组成功挑战腹中“逆世界”,为1例来自汕尾、因全内脏反位合并胃癌的古稀老人,完成了腹腔镜胃肠肿瘤微创手术。据可查文献,此属国内首例。

患者为69岁男性,2014年11月初,在当地医院胃肠镜检查发现患有胃癌。因其为全内脏反位的患者(俗称“镜面人”)遂到广东省人民医院普通外科就诊。通常情况下,这样的特殊病例多考虑开腹手术,但为了把手术创伤降到最低,普通外科一区主任李勇决定应用腹腔镜微创手术为其治疗。

11月27日,由首诊医生曾穗德担任主刀为患者进行腹腔镜远端胃癌根治术。经术中腹腔镜探查示:患者肝、胆囊、脾、肾等全部器官均反位,肿瘤位于胃窦,大小约4cm×5cm。手术中,医生并未将患者手术体位、手术所需器械及腹腔显示系统进行调整,而是将后腹腔镜戳卡孔、术者站位及操作习惯进行“反转”调整和改变,“逆向思维”仔细辨清血管、神经、淋巴结分布。严格按照术前制定的每一个步骤有条不紊地进行操作,历时3小时终于顺利完成了手术。术中出血仅仅50ml。在围手术期贯彻科室“快康复”新理念,患者次日通过手术中留置的鼻肠营养管输注肠内营养,并逐步开始下地活动,手术后第3日拔除胃管并开始进食,手术后第5天患者身体基本康复。

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