腹腔镜辅助中央入路根治性右半结肠切除术  

Laparoscopic-assisted central approach radical right hemicolectomy

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作  者:张一楠 步召德[1] Zhang Yinan;Bu Zhaode(Key Laboratory of Carcinogenesis and Translational Research(Ministry of Education/Bejing),Gastrointestinal Cancer Center Unit 2,Peking University Cancer Hospital&Institute,Beijing 100142,China)

机构地区:[1]北京大学肿瘤医院暨北京市肿瘤防治研究所胃肠肿瘤中心二病区,恶性肿瘤发病机制及转化研究教育部重点实验室,北京100142

出  处:《中华普外科手术学杂志(电子版)》2022年第5期493-493,共1页Chinese Journal of Operative Procedures of General Surgery(Electronic Edition)

摘  要:患者全身麻醉后,5孔法建立气腹,术者左侧站位。探查腹腔未见转移,行腹腔镜辅助中央入路根治性右半结肠切除术。手术步骤:充分显露右半结肠系膜,辨认回结肠血管,沿肠系膜上静脉投影切开右半结肠系膜根部,进人Toldt's间隙。分离显露回结肠血管并清扫淋巴结,进而显露肠系膜上静脉。向头侧拓展显露肠系膜上静脉并清扫血管根部淋巴结。显露右结肠、中结肠血管,清扫其根部淋巴结。结扎离断回结肠血管、右结肠血管及中结肠血管右支。向头侧及外侧拓展Toldt's间隙,分离回肠系膜根部,最后从外侧游离升结肠与内侧贯通,完成右半结肠游离。修整回肠,距回盲部10cm离断血管弓。采用5cm上腹正中辅助切口,完成回肠-横结肠端侧吻合并移除标本。Aferthe patient was anesthetized,pneumopertioneum was established by the 5-hole method,and the surgeon was left sided.No metastases were found in the abdominal cavity,then the laparoscopic-assisted central approach radical right hemicolectomy was perfomed.Surgical steps:after fully expose the right mesentery and identify the ileocolonic vessels,incise the root of the right mesentery along the projection of the superior mesenteric vein,entering the Toldt's space.The ileocolic vessels were isolated and the lymph nodes were dissected.The superor mesenteric vein was exposed and the lymph nodes at the root of the vessel were dissected.The right colon vessel and the middle colon vessel were exposed,and the lymph nodes were dissected.The ileocolonic vessels,the right colonic vessels and the right branch of the middle colonic vessels were ligated and transected.The Toldt's space was expanded from the lateral side and connected to the medial side to complete the dissociation of the right colon.The ileum vascular arch was transected 10 cm from the ileocecal region.The ileum-transverse colon end-to-side anastomosis was completed by a 5cm assisted incision and at last,the specimen was removed.

关 键 词:结肠肿瘤 腹腔镜 结肠切除术 中央入路 

分 类 号:R735.35[医药卫生—肿瘤]

 

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