摘要
随着微创技术的不断发展,腹腔镜手术已成为结直肠癌根治术的金标准。在腹腔镜右半结肠癌根治手术中,由于涉及脏器多,手术风险高,技术难度大,尤其是在肥胖、系膜充血水肿的病例中操作尤为困难。作者在大量的腹腔镜结肠癌手术实践及对腹腔镜下右半结肠解剖理解的基础上,笔者提出尾侧入路法,即以小肠系膜与后腹膜愈着的"黄白交界线"为手术入路,"搭帐篷式"优先解剖肠系膜上静脉后方(右半结肠系膜后叶)、胰十二指肠前筋膜前方所在的Toldt′s融合筋膜间隙,两面夹击法完成中央组淋巴结的清扫,最后才游离升结肠后方所在的Toldt′s间隙及侧腹膜的手术入路。本文章就实施腹腔镜右半结肠癌根治性切除术,总结其技术特点,探讨其技术可行性及优势。
With the development of minimally invasive surgery,laparoscopic surgery has becomethe gold standard for colon cancer.There is involved high risk in laparoscopic radical right colectomy forits complex anatomical structure,especially for the cases with obesity and mesentery edema.Based onour previous clinical practice of laparoscopic surgery for colon cancer and further understanding of colonmesentery,the author forwards a caudal-to-cranial approach for laparoscopic radical right colectomy to makethe procedure easier.Cut the peritoneum along the line between the right mesocolon and retroperitoneum,enter the Toldt′s space to dissect the posterior of SMV/SMA and their branches,and then finished the D3dissection from caudal to cranial on both sides of the mesentery along the SMV.In the end,cut the lateralligament to mobilize the posterior space of ascending colon.This approach is called caudal-to-cranialapproach.Here,the paper to conclude its techniques and advantages.
作者
邹瞭南
郑蓓诗
卢新泉
刘鹏飞
万进
Zou Liaonan;Zheng Beishi;Lu Xinquan;Liu Pengfei;Wan Jin(Department of Gastrointestinal Surgery, Guangdong Province Hospital of Chinese Medicine, Guangzhou 510120, China)
出处
《中华结直肠疾病电子杂志》
2017年第2期170-173,共4页
Chinese Journal of Colorectal Diseases(Electronic Edition)
基金
广东省科学技术厅科技计划项目[No.2015A030401082
No.110号(2015)]
关键词
结直肠肿瘤
腹腔镜
尾侧入路法
腹腔镜手术
Colorectal neoplasms
Laparoscopes
Caudal-to-cranial approach
Laparoscopic surgery