腹腔镜下右半结肠全系膜切除术

Laparoscopic Complete Mesocolic Excision （CME） for Right Colonic Cancer

患者为老年男性,临床分期为c T4N0M0,术后病理分期为p T4aN1M0。采用“四步法”：1.沿肠系膜上静脉走向充分显露肠系膜上静脉,整块清除外科干淋巴结、胰头前及第6组淋巴结,进入并分离胰十二指肠前间隙。2.进一步扩大胰十二指肠前间隙并游离右肾前间隙至右结肠旁沟,沿此间隙游离升结肠及回盲部后方。3.切开回结肠反折腹膜及升结肠侧腹膜。4.切除右侧大网膜、第6组淋巴结,切开肝结肠韧带。腹腔镜下操作完成。

It was an elder male patient , with clinical stage of cT 4 N0 M0 and pathologic stage of pT4a N1 M0 .＆quot;Four-step method＆quot;were performed in laparoscopic total mesorectal excision for right colonic cancer, as following：1.Firstly, we fully exposed the superior mesenteric vein , then the en bloc resection of lymph nodes was performed along surgical trunk , former fascial of the pancreatic head and the sixth group of lymph nodes.Thereafter, pancreatic and duodenal former space was divided .2.Secondly, we further dissected the pancreatic and duodenal former space to Gerota fascial and right paracolic sulci .Thereafter , ascending colon and ileocecus was divided .3.Thirdly, we dissected ileocecal peritoneum and ascending colon lateral peritoneum.4.Finally, the right part of great omentum and sixth group of lymph nodes were resected, and the hepatocolic ligament was dissected .Thereafter laparoscopic operation was completed .