Hana Hana ma Laparoscopic Total Gastrectomy

Hana Hana ma Laparoscopic Total Gastrectomy

Abstract, Pahuhopu: E kūkākūkā i ka hui hana a me ka ʻike kahu hānai o ka laparoscopic total gastrectomy.Nā Hana Ua nānā ʻia ka ʻikepili lapaʻau o nā maʻi he 11 i loaʻa i ka laparoscopic total gastrectomy.Nā hopena Ua hoʻokuʻu ʻia nā maʻi he ʻumikūmākahi i loaʻa i ka laparoscopic total gastrectomy me ka ʻole o nā pilikia koʻikoʻi.
Ka hopena: ʻO ka laparoscopic total gastrectomy ka liʻiliʻi o ka trauma, ʻoi aku ka wikiwiki o ka pau ʻana, ka liʻiliʻi o ka ʻeha a me ka wikiwiki o ka hoʻihoʻi ʻana i ka postoperative no nā maʻi.Pono i ka noi lapaʻau.
Hua'ōlelo nui laparoscopy;holoʻokoʻa gastrectomy;hana hui;ʻoki ʻoki laparoscopic kokoke
Me ka hoʻonui ʻia ʻana o nā manaʻo hōʻemi liʻiliʻi invasive o kēia wā, ua hoʻohana nui ʻia ka ʻenehana laparoscopic i ka hana lapaʻau.Loaʻa i ka laparoscopic nā mea maikaʻi o ka emi ʻana o ke koko intraoperative, liʻiliʻi i ka ʻeha postoperative, ka wikiwiki o ka hoʻihoʻi ʻana i ka hana o ka ʻōpū, ka noho pōkole o ka haukapila, ka liʻiliʻi o ka ʻōpū o ka ʻōpū, ka liʻiliʻi o ka hopena i ka hana immune o ke kino, a me ka liʻiliʻi o nā pilikia [1].I nā makahiki i hala iho nei, me ka hoʻomau mau ʻana o ka ʻenehana laparoscopic, ʻoi aku ka nui o nā mea maʻi me ka maʻi maʻi ʻōpū e mālama ʻia e ka ʻoki laparoscopic.He paʻakikī ka hana ʻana o ka laparoscopic total gastrectomy a koi i kahi pae ʻenehana kiʻekiʻe, a koi i ka launa pū ʻana ma waena o ke kauā a me ke kahu hānai i loko o ka lumi hana e hōʻoia i ka hoʻopau ʻana o ka hana.He ʻumikūmākahi mau maʻi i loaʻa i ka laparoscopic total gastrectomy ma ko mākou haukapila mai Malaki 2014 a hiki i Pepeluali 2015 i koho ʻia no ka nānā ʻana, a ua hōʻike ʻia ka hui ʻana o nā kahu hānai.
1 Nā mea a me nā ʻano hana
1.1 ʻIke Nui Ua koho ʻia he ʻumikūmākahi mau maʻi i loaʻa i ka laparoscopic total gastrectomy ma ko mākou haukapila mai Malaki 2014 a hiki i Feberuari 2015, me 7 kāne a me 4 wahine, ʻo 41-75 mau makahiki, me ka awelika o nā makahiki he 55.7 makahiki.Ua hōʻoia ʻia ka maʻi maʻi maʻi e ka gastroscopy a me ka biopsy pathological ma mua o ka hana ʻana i nā mea maʻi āpau, a ʻo ka pae mua o ka lāʻau lapaʻau ka pae I;he moʻolelo o ka ʻoki ʻōpū o luna a i ʻole ka ʻoki ʻōpū nui i ka wā i hala.
1.2 ʻO ke kaʻina hana Ua loaʻa nā maʻi āpau i ka laparoscopic radical total gastrectomy.Ua mālama ʻia nā maʻi āpau me ka maʻi maʻi maʻamau a me ka intubation tracheal.Ma lalo o ka pneumoperitoneum, ua hoʻokaʻawale ʻia ka omentum a me ka omentum me ka ultrasonic scalpel a me Ligasure e wehe i nā kīʻaha koko perigastric, a ua hoʻomaʻemaʻe ʻia nā lymph nodes a puni ka ʻaʻa ʻāʻī hema, ke aʻa hepatic, a me ke aʻa splenic.Ua hoʻokaʻawale ʻia ka ʻōpū a me ka duodenum, ka ʻōpū a me ka cardia e ka ʻoki laparoscopic a me ka mea pani pani, no laila ua manuahi ka ʻōpū holoʻokoʻa.Hoʻokiʻekiʻe ʻia ka jejunum kokoke i ka esophagus, a ua hana ʻia kahi puka liʻiliʻi i kēlā me kēia o ka esophagus a me ka jejunum, a ua hana ʻia ka ʻaoʻao esophagus-jejunum anastomosis me kahi ʻoki laparoscopic a pani ʻia, a ua pani ʻia ka wehe ʻana o ka esophagus a me ka jejunum. me ka ʻoki laparoscopic a pani pani.Pēlā nō, ua hoʻopili ʻia ka hope manuahi o ka jejunum i ka jejunum 40cm ka mamao mai ka ligament suspensory o ka duodenum.Ua hana ʻia kahi ʻoki 5cm ma waena o ka waha haʻahaʻa o ke kaʻina xiphoid a me ke kaula umbilical e wehe i ke kino ʻōpū.Hoʻokaʻawale ʻia nā ʻāpana o ke kino a me ka lymph node a hoʻouna ʻia no ka hoʻokolokolo pathological.Ua holoi ʻia ka ʻōpū peritoneal me ka paʻakai fluorouracil, a ua kau ʻia kahi paipu hoʻoheheʻe e pani ai i ka ʻōpū o ka ʻōpū [2].Wehe ʻia ka trocar a humuhumu ʻia kēlā me kēia poke.
1.3 E kipa mua i ka mea maʻi ma ke keʻena 1 lā ma mua o ka hana e hoʻomaopopo i ke kūlana maʻamau o ka mea maʻi, e nānā i ka hihia, a nānā i nā hopena o nā hoʻokolohua like ʻole.E komo i ka kūkākūkā preoperative i loko o ka 'oihana ina pono, a me ka hoʻomākaukau piha no ka hana ma ka lua o ka lā.ʻO ka Laparoscopic Gastric Cancer Resection He ʻano hana lapaʻau hou nō ia, a ʻaʻole lawa ka ʻike o ka hapa nui o ka poʻe maʻi e pili ana iā ia a ke kānalua nei lākou no ia mea.Ma muli o ka ʻike ʻole, hopohopo lākou e pili ana i ka hopena curative a me ka palekana o ka hana, a laila e loaʻa nā pilikia noʻonoʻo e like me ka hopohopo, ka hopohopo, ka makaʻu a me ka makemake ʻole e hana.Ma mua o ka hana ʻana, i mea e hoʻopau ai i ka hopohopo o ka mea maʻi a ʻoi aku ka maikaʻi o ka launa pū ʻana me ka lāʻau lapaʻau, pono e wehewehe i ka palekana a me ka pono o ka hana i ka mea maʻi, a hoʻohana i ka hana kūleʻa i kumu hoʻohālike e hoʻonui ai i ka manaʻo o ka mea maʻi. hilinaʻi lapaʻau.E mālama ka poʻe maʻi i kahi kūlana hoʻomaha o ka noʻonoʻo a kūkulu i ka hilinaʻi i ka hakakā ʻana i ka maʻi.
1.4 Ka hoʻomākaukau ʻana i nā mea hana a me nā mea: 1 lā ma mua o ka hana, e nānā me ke kauka lapaʻau inā loaʻa nā koi kūikawā o nā mea hana, inā paha he loli i nā ʻanuʻu hana maʻamau, a e hana i nā hoʻomākaukau kūpono ma mua.E hoʻomākaukau maʻamau i nā mea ʻokiʻoki laparoscopic a nānā i ke kūlana disinfection, a e nānā inā paʻa a maʻalahi ka hoʻohana ʻana i ka ultrasonic scalpel, monitor, light source, pneumoperitoneum source a me nā mea hana ʻē aʻe.E hoʻomākaukau a hoʻopau i nā ʻano like ʻolepani ʻoki ʻoki laparoscopicatubular stapler.E like me nā hana laparoscopic ʻē aʻe, ke alo pū nei ka laparoscopic total gastrectomy i ka pilikia o ka hoʻololi ʻana i ka laparotomy, no laila pono e hoʻomākaukau mau ʻia nā mea hana laparotomy.I ʻole e hoʻopilikia i ka holomua o ka hana ma muli o ka lawa ʻole o ka hoʻomākaukau ʻana i ka wā o ka hana, a i ʻole e hoʻoweliweli i ke ola o ka mea maʻi.
1.5 E hui pū me ka mea maʻi i ka wā o ka hana a hoʻokumu i ke komo venous ma hope o ka nānā ʻana i ka ʻike ʻike pololei.Ma hope o ke kōkua ʻana i ka mea maʻi maʻi e hana i ka anesthesia, e kau i ka mea maʻi ma kahi kūpono a hoʻoponopono iā ia, e kau i kahi catheter mimi, a hoʻoponopono pono i ka paipu decompression o ka ʻōpū.Holoi nā kahu maʻi i ko lākou mau lima 20 mau minuke ma mua, a helu i nā mea hana, nā lole, nā nila a me nā mea ʻē aʻe me nā kahu hānai holo.E kōkua i ke kauka lapaʻau e hoʻomaʻemaʻe i ka mea maʻi, a e hoʻohana i ka lima pale sterile e hoʻokaʻawale i ka laina lens, laina kumu māmā, a me ka laina pahi kani ultrasonic [3].E nānā inā ʻaʻole keakea ʻia ka nila pneumoperitoneum a me ke poʻo aspirator, hoʻoponopono i ka pahi kani ultrasonic;E kōkua i ke kauka e hoʻokumu i ka pneumoperitoneum, e hele i ka trocar laparoscopic exploration e hōʻoia i ka ʻōpū, e hāʻawi i nā mea kani a me nā mea e pono ai no ka hana i ka manawa, a kōkua i ke kauka e hoʻopau i ka ʻōpū o ka ʻōpū i ka wā o ka hana.I ka wā o ka hana, pono e hoʻokō pono ʻia nā ʻenehana aseptic a me ka ʻole o ka tumo.ʻO ka hoʻokomo ʻana i ka pahu pahu koʻikoʻi i hilinaʻi maoli ʻia i ka wā e hele kokoke ana i ka ʻoki laparoscopic, a hiki ke hāʻawi ʻia i ka mea hoʻohana wale nō ma hope o ka hōʻoia ʻana o ke kumu hoʻohālike.E pani i ka ʻōpū a nānā hou i nā mea hana, ka gauze, a me nā nila humuhumu.
2 hopena
ʻAʻohe o nā maʻi 11 i hoʻololi i ka laparotomy, a ua pau nā hana āpau ma lalo o ka laparoscopy piha.Ua hoʻounaʻia nā maʻi a pau no ka nānāʻana i ka pathological, aʻo nā hopena i hōʻikeʻia i ka postoperative TNM staging o nā maʻi maʻi maʻi maʻi he pae I. ʻO ka manawa hana he 3.0 ~ 4.5h,ʻo ka manawa maʻamau he 3.8h;ʻo ke kahe o ke koko i ka wā o ka hana he 100 ~ 220ml, ʻo ka awelika o ke koko he 160ml, a ʻaʻohe kahe koko.Ua ola maikaʻi nā maʻi āpau a ua hoʻokuʻu ʻia mai ka haukapila 3 a 5 mau lā ma hope o ka hana.ʻAʻohe pilikia o nā maʻi a pau e like me ka leakage anastomotic, ka maʻi ʻōpū, ka maʻi ʻokiʻoki, a me ke kahe koko o ka ʻōpū, a ua ʻoluʻolu ka hopena o ka ʻoki.
3 Kūkākūkā
'O ka ma'i 'a'ai 'o ia kekahi o nā ma'i ma'i ma'amau i ko'u'āina.Hiki ke pili i nā mea e like me ka meaʻai, ka honua, ka ʻuhane a i ʻole genetics.Hiki ke hana ia ma kekahi ʻāpana o ka ʻōpū, hoʻoweliweli koʻikoʻi i ke olakino kino a me ka noʻonoʻo a me ka palekana ola o nā maʻi.I kēia manawa, ʻoi aku ka maikaʻi o ka lāʻau lapaʻau ʻO ke ʻano o ka ʻokiʻoki ʻana, akā nui ka ʻeha maʻamau, a ʻo kekahi poʻe maʻi ʻelemakule a i ʻole nā ​​​​poʻe maʻi kino e nalowale ka manawa kūpono no ka mālama ʻana ma muli o ka intolerance [4].I nā makahiki i hala iho nei, me ka hoʻomau mau ʻana o ka hoʻomohala ʻana, ka hoʻomaikaʻi ʻana a me ka hoʻohana ʻana i ka ʻenehana laparoscopic i ka hana lapaʻau, ua hoʻonui hou ʻia nā hōʻailona no ke ʻoki.Ua hōʻike ʻia nā haʻawina kūloko a me nā ʻāina ʻē he ʻoi aku ka maikaʻi o ka ʻoki ʻana ma mua o ka hana maʻamau i ka mālama ʻana i ka maʻi maʻi ʻōpū.Akā ke kau nei i mua i nā koi kiʻekiʻe no ka launa pū ʻana ma waena o ke kauka lapaʻau a me ke kahu hānai ma ka lumi hana.I ka manawa like, pono e hana maikaʻi nā kahu hānai ma ka lumi hana i nā kipa mua a kamaʻilio pū me nā maʻi e hoʻomaopopo i ke kūlana noʻonoʻo a me ke kūlana kino o ka mea maʻi.E hoʻomaikaʻi i ka hoʻomākaukau ʻana no nā mea ʻokiʻoki a me ka lumi hana ma mua o ka hana ʻana, i hoʻonohonoho pono ʻia nā mea i ke ʻano kūpono, kūpono a me ka manawa;i ka wā o ka hana, e nānā pono i ka puka ʻana o ka mimi o ka mea maʻi, ka nui o ke koko, nā hōʻailona koʻikoʻi a me nā hōʻailona ʻē aʻe;E wānana mua i ke kaʻina hana, e hāʻawi i nā mea hana i ka manawa a me ka pololei, e haku i nā loina, hoʻohana a mālama maʻalahi i nā mea hana endoscopic like ʻole, a e hōʻoia i ka holomua o ka hana i ka nui loa.ʻO ka hana aseptic koʻikoʻi, ka hoʻokō pono a me ka hoʻoikaika ʻana i ka hana ʻana nā kī e hōʻoia i ka hoʻokō maʻalahi o ka hana.
I ka hōʻuluʻulu ʻana, ʻoi aku ka liʻiliʻi o ka ʻeha nui o ka laparoscopic gastrectomy, ʻoi aku ka wikiwiki o ka pau ʻana, ka liʻiliʻi o ka ʻeha a me ka wikiwiki o ka hoʻihoʻi ʻana i ka postoperative no nā maʻi.Pono i ka noi lapaʻau.

mau kuhikuhi
[1] ʻO Wang Tao, Song Feng, Yin Caixia.ʻO ka hui kahu hānai ma ka laparoscopic gastrectomy.Ka Nupepa Kina o nā kahu hānai, 2004, 10 (39): 760-761.
[2] Li Jin, Zhang Xuefeng, Wang Xize, et al.Ka hoʻohana ʻana o LigaSure i ka ʻoki ʻana i ka ʻōpū laparoscopic.ʻO ka puke moʻolelo Pākē o ka ʻoki ʻoki liʻiliʻi, 2004, 4 (6): 493-494.
[3] Xu Min, Deng Zhihong.ʻO ka hui pū ʻana i ka laparoscopic kōkua distal gastrectomy.Nūpepa o nā kahu hānai, 2010, 25 (20): 1920.
[4] Du Jianjun, Wang Fei, Zhao Qingchuan, et al.He hōʻike ma 150 mau hihia o ka laparoscopic D2 radical gastrectomy no ka maʻi maʻi ʻōpū.Ka Nupepa Kina o ka Endoscopic Surgery (Electronic Edition), 2012, 5 (4): 36-39.

Puna: Baidu Library