腹腔镜直肠癌前切除术

Laparoscopic anterior resection in treating rectal cancers

直肠癌前切除术中保留左结肠动脉能有效保证吻合口的血供,减少术后吻合口漏发生概率。术中于乙状结肠系膜内侧打开浆膜,分离至肾前间隙,向左、向尾侧、向头侧进一步游离、扩大该间隙,显露并注意保护左侧输尿管、左侧生殖血管。充分游离肾前间隙后,放入小纱布以作标记。提起肠系膜下血管根部系膜组织,彻底分离清扫肠系膜下动脉根部淋巴脂肪组织。清晰显露左结肠动脉的走行方向,注意保护之,在其远端夹闭、切断肠系膜下动脉,以保证近端肠管血运。其余步骤按腹腔镜下全直肠系膜切除法+双吻合器法切除直肠肿瘤及重建肠道。

In the operative procedures, the preservation of the left colonic artery ensured the blood supply of stoma with decreased incidence of fistula. In our practice, this technique was used to dissect the serosa from the medial side of the sigmoid mesocolon to the pre-renal gap, and to expand the space to the left, tail and head sides, and to protect the left ureter and reproductive vessels. After the separation of the pre-renal gap, a small piece of gauze was put in for marking. Then the subsequent steps were taken to lift the mesenteric tissue of the inferior mesenteric vascular roots, and separate and clean up the lymphatic adipose tissue of the inferior mesenteric artery roots. It is essential to clearly expose the travel direction of the left colic artery and protect it, clip and cut the inferior mesenteric artery at the distal end, and ensure the blood supply of the proximal intestine. The rest steps are similar to laparoscopic total mesorectal excision ＋ double stapling method resection of rectal tumor and reconstruction of the intestinal tract.