腹腔镜下往复式右半结肠D3/CME根治术

Reciprocating operative procedures of laparoscopic complete mesocolon excision of right-hemicolon with D3 lymphadenectomy

步骤包括:1先切开腹膜显露肠系膜上静脉(SMV)。并于中结肠血管左侧辨认胰颈下缘,进入小网膜囊;2沿SMV左侧缘纵向反复多次切开薄层脂肪组织,以显露可能的结肠动脉分支(回结肠动脉或右结肠动脉及中结肠动脉),并结扎处理,充分显露SMV的全长;3结扎处理中结肠静脉汇入SMV的属支后,与SMV右侧处理回结肠静脉;4沿SMV右侧向胰颈分离,显露胃结肠干的各个分支,单独切断右结肠静脉/或胃网膜右静脉;5分离胰十二指肠前间隙和Toldt间隙,游离结肠,脐周切口完成吻合。特点:1纵向显露SMV左侧缘全长后再处理各静脉属支,简化各静脉属支的显露;2以胰腺颈部为标示,处理静脉属支更加安全。腹腔镜下往复式右半结肠D3/CME根治术简单、安全、可行。

Briefly as following： firstly, superior mesenteric vein was exposed by dissecting peritoneum upwardly to the inferior margin of pancreatic neck and into lessor omental bursa .Secondly , branches （ including ileocolic artery , right hemicolon artery and middle colic artery ） of SMV were divided at their roots respectively along the left side of SMV , which ensured the complete expose of SMV .Thirdly, branches （ including ileocolic vein and middle colic vein ） of SMV were divided respectively .Fourthly, Henle’s trunk was dissected along the right side of SMV , and right hemicolon vein and/or right gastroepiploic vein were divided selectively .Finally, pancreaticoduodenal anterior space and Toldt＆#39;s space were separeted , which ensured the mobilization of right hemicolon , thereafter anastomosis was performed out of abdominal cavity through peri-umbilicus incision. Summary：Firstly, reciprocating dissection were performed along left side of SMV ensuring simplified operative procedures of branch veins expose .Secondly , with the symbol of pancreatic neck , individual division of colonic veins could be performed safely .This novel technique is safe and effective .