腹腔镜右半结肠癌CME切除术——尾侧中间联合入路

Laparoscopic completed mesocolic excision for right colon cancer:a hybrid of caudal-medial approach

手术遵循完整结肠系膜切除原则。手术过程包括:探查腹腔;自尾侧从末端回肠系膜根部黄白交界线打开系膜,进入右结肠后间隙,向头侧,外侧拓展该间隙,至十二指肠水平;回到传统中间入路,回结肠血管下方打开结肠系膜,与尾侧方向打开的间隙会师;解剖并高位结扎切断回结肠血管、打开肠系膜上静脉血管鞘,清扫外科干,高位结扎切断右结肠血管、中结肠血管右支,继续拓展分离右结肠后间隙、横结肠后间隙,直至胰腺下缘并进入小网膜囊;打开胃结肠韧带,游离结肠肝曲;打开右侧腹膜,完成肠段游离,体外切除标本、重建消化道。

The surgical procedure should obey the principles of complete mesocolic excision（CME）. Surgical procedure includes： abdominal exploration,first dissection was performed at the root of the meso-ilium caudally,then to enter and expand the right retro-colic space（ RRCS） to the third part of duodenum,and back to medial approach,to open the mesocolon below the ileocolic vessel,to meet the opened RRCS,and followed by a high ligation and dissection of vessels,including the superior mesocolic vessel,right colic vessel and right branch of middle colic vessel,after dissection of Toldt ＇s space and ligament of hepatic flexure, whole right hemicolon was mobilized, and specimen was removed extracorporeally,finally reconstruction of the GI were achieved.