腹腔镜中间入路法右半结肠切除术解剖学观察

Anatomy of the laparoscopic right hemicolectomy through medial access

目的:探讨腹腔镜右半结肠切除术中线入路相关活体解剖学特点。方法:对2004年1月至2006年12月我科施行的21例腹腔镜中间入路右半结肠切除术手术录像进行观察分析。结果:利用中间入路,以肠系膜上静脉为解剖学标志,可成功进行系膜血管的解剖、淋巴结清扫,并进入正确的外科平面。结肠系膜和肾前筋膜之间存在融合筋膜间隙,其内侧、外侧、腹侧、背侧的边界分别是肠系膜上静脉、右结肠旁沟、结肠系膜、肾前筋膜。胃结肠韧带、肝结肠韧带和结肠外侧腹膜返折等外周固定装置是右半结肠切除术中必须离断的结构。结论:在腹腔镜中间入路右半结肠切除术中,肠系膜上静脉是关键解剖学标志和主线,融合筋膜间隙是正确的外科平面;一系列外周腹膜结构是重要固定装置。

Objective： To explore anatomic features during the laparoscopic right hemicolectomy through medial access. Methods： Anatomic observation and analysis were carried out on 21 patients undergoing laparoseopic right hemicolectomy through medial approach from January 2004 to December 2006. Results： Dissection of mesenteric vessels, lymphadenectomy, and identification of the surgical plane were guided by the landmark of the superior mesenteric vein （SMV）. Located between the mesocolon and the prerenal fascia, there was a fusion fascia space which was bounded medially, laterally, ventrally, dorsally respectively by the SMV, the pouch lateral to the right colon, the mesocolon and the prerenal fascia. The gastrocolic ligament, the hepatocolic ligament and the peritoneal reflexion lateral to the colon were peripheral attachments which should be divided in the right hemicolectomy. Concusions： The SMV is the key landmark and the main line of great importance, the fusion fascia space is the right surgical plane, as well as a series of peripheral peritoneal attachments are importment fixations in laparoscopic right hemicolectomy by medial access.