腹腔镜低位直肠癌前切除术

Laparoscopic anterior resection of rectal cancer

直肠上段癌前切除术。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。

Laparoscopic anterior resection of rectal cancer. Firstly,to dissect the sigmoid mesocolon by medial approach to the pararenal space,and to expand from left to right and upwards,then to expose and protect the left ureter and reproductive vasculars. After sufficiently exposing the pararenal space,a piece of gauze was left for marking. Thus the mesenteric tissue of inferior mesenteric vascular roots was dissected,and lymphadenectomy was performed. Clearly exposing and protecting left colic artery,then cutting inferior mesenteric artery at distal branch,to preserve blood supply of proximal intestine. The rest operative procedures are similar to laparoscopic total mesorectal excision ＋ double stapler method for rectal tumor and fro the reconstruction of intestinal tract.