腹腔镜下保留左结肠动脉的低位直肠癌根治术  

Laparoscopic radical resection of low rectal cancer with preservation of left colon artery

作　　者：陈纲 李涛[1] 李世拥 Chen Gang;Li Tao;Li Shiyong(Department of General Surgery,the 7th Medical Center of PLA General Hospital,Beijing 100700,China)

机构地区：[1]解放军总医院普通外科医学部派驻第七医学中心普通外科,北京100700

出　　处：《中华普外科手术学杂志（电子版）》2023年第5期485-485,共1页Chinese Journal of Operative Procedures of General Surgery(Electronic Edition)

摘　　要：腹腔镜下保留左结肠动脉的低位直肠癌根治术,遵循TME原则和神经功能保护原则,旨在最大程度的保留吻合口血供和植物神经功能,该手术在减少手术并发症和加速康复方面具有显著优势。患者取截石位,于气管插管全身麻醉下采用五孔法:首先分离乙状结肠与侧腹壁粘连并显露乙状结肠隐窝,转至乙状结肠系膜右侧,骶岬前方打开腹膜进入Toldt’s间隙,分离直肠上动脉、肠系膜上动脉及左结肠动脉,清扫253组淋巴结,结扎并离断直肠上动脉,TME原则下向尾侧游离直肠及其系膜至盆底肌水平,期间离断Denonvilliers筋膜及直肠侧韧带,保护血管神经束,距肿瘤远端2 cm以上离断直肠。左下腹经腹直肌切口,裁剪结肠系膜后移除标本,近端肠管置抵钉座,重新建立气腹,直视下行直肠-结肠端端吻合。Laparoscopic anterior resection for low rectal cancer with preservation of the left colonic artery,following the principles of TME and neural function preservation,aims to maximize anastomosis blood supply and maintain autonomic neural function.The surgery has significant advantages in reducing surgical complications and accelerating recovery.The surgical procedure involves a five-port technique under endotracheal intubation and general anesthesia.Firstly,the sigmoid colon is dissected from the lateral abdominal wall,then the sigmoid mesocolic gutteris exposed.The dissection proceeds to the right side of the mesentery,entering the Toldt’s space in front of the sacroiliac promontory.The superior rectal artery,the superior mesenteric artery,and the left colonic artery are carefully dissected,and 253 lymph nodes are dissected.The superior rectal artery is ligated and divided according to the principles of TME.The rectum and its mesentery are separated until reaching the level of the pelvic muscle,with the Denonvilliers fascia and the lateral ligaments of the rectum being preserved to protect the vascular and nerve bundles.The rectum is divided at least 2 cm distal to the tumor.A transverse incision is made in the lower left abdomen,and the mesentery of the colon is dissected and the specimen is removed.The proximal end of the colon is placed the stapler seat,and pneumoperitoneum is reestablished.The rectal-colonic anastomosis is created under direct visualization.

关 键 词：直肠肿瘤 全直肠系膜切除术 腹腔镜 保留左结肠动脉 

分 类 号：R735.37[医药卫生—肿瘤]