腹腔镜中间入路扩大右半结肠癌D3根治术

Laparoscopic extended right hemicolectomy with D3 lymph- adenectomy using a medial-to.lateral approach

肿瘤位于结肠肝曲或其远端10cm以内是扩大右半结肠癌根治术的手术指征。因为术中需要清扫幽门下淋巴结和中结肠血管根部淋巴结，其周围解剖结构复杂，所以腹腔镜扩大右半结肠癌D3根治术是腹腔镜结肠癌根治术中难度最大的术式。

Laparoscopic colectomy is commonly per- formed, but laparoscopic extended right hemieolectomy with D3 lymphadeneetomy for cancer located at hepatic flexure of the colon is a complex procedure, even in the hands of experts. Laparoscopic dissection of the lymph nodes around the middle colonic and right gastroepiploic vessels are so complicated that precise vascular anatomy and surgical plane are essential to com- plete this procedure safely. We herein describe a standard tech- nique for performing laparoscopic extended right hemicolectomy with D3 lymphadenectomy using a medial-to-lateral approach. The main surgical plane of this procedure is the right Toldt＇s space. The superior mesenteric vein （SMV） is the most impor- tant anatomical landmark of vascular dissection. Medial-to-lateral approach makes it easy to locate the right Toldt＇s space and the SMV.