腹腔镜直肠癌切除肠系膜血管裸化及左结肠动脉保留术

Mesenteric vascular dissection and left colon artery retention in laparoscopic rectal cancer resection

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。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。

Anterior resection of rectal carcinoma with the preservation of the left colonic artery could ensure the blood supply of anastomosis and reduce the incidence of postoperative anastomotic leakage .The operation is performed with opening the serosa from the medial side of the sigmoid mesocolon , dissecting into the pre-renal gap, exposing to the left tail and head direction for the protection of the left ureter and reproductive vasculars .After fully separating the prerenal gap , a small piece of gauze was used to mark . Lifting the mesenteric tissue of the inferior mesenteric vascular roots , separating and cleansing the lymphatic adipose tissue of the inferior mesenteric artery roots completely .Then the travel direction of the left colic artery should be clearly exposed and protected , further the inferior mesenteric artery was clipped and cut at the distal proximity to ensure the blood supply of the proximal intestine .The rest procedures are similar to laparoscopic total mesorectal excision and double stapling resection of rectal tumor and reconstruction of the intestinal tract .