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一、根治性远侧胃大部切除Ⅰ型:原发灶:远侧切断线:十二指肠至少切除3cm。(可疑时作冰冻切片决定)。近侧切断线:小弯侧在贲门下2～3cm 处,大弯侧距肿瘤近侧至少5cm 处。淋巴范围:切除全部大网膜,包括远侧两支胃短动脉,全部肝胃韧带,肝十二指肠韧带的前叶,横结肠系膜的浅叶及胰腺被膜,根部结扎切除胃左、右及胃网膜左、右动脉。Ⅱ型:Ⅰ型+清扫肝总动脉前,贲门右及胰十二指肠后的淋巴区。
A, radical distal gastrectomy type I: primary lesion: distal cut line: duodenum at least 3cm. (Determination of frozen sections when suspicious). Proximal cutting line: The small curve side is 2~3cm below the cardia, and the large curve side is at least 5cm proximal to the tumor. Lymphatic range: removal of the entire omentum, including the two short stomachs distal to each other, all of the hepatogastric ligaments, the anterior lobe of the hepatoduodenal ligament, the superficial lobe of the transverse mesocolon, and the pancreas capsule. The roots are ligated to resect the left and right sides of the stomach. Gastric omental left and right arteries. Type II: Type I + lymph node before cleaning the common hepatic artery, right at the cardia, and after the pancreatic duodenum.