尾侧入路腹腔镜右半结肠癌CME术

Laparoscopic complete mesocolic excision for right colon cancer by using a caudal-medial approach

主要步骤包括:(1)腹腔探查;(2)右结肠后间隙(RRCS)拓展:进入Told筋膜与结肠系膜间的天然外科平面。至结肠肝曲水平,同时向内侧暴露十二指肠,此为进入横结肠后间隙(TRCS)的标志。(3)中间入路结扎肠系膜血管:以回结肠血管(ICV,ICA)在肠系膜表面投影为解剖标志打开结肠系膜,可轻易与其后方已打开的RRCS间隙相汇合。以肠系膜上静脉(SMV)为主线,清扫外科干,进一步解剖Henle’s干及其分支。(4)幽门下淋巴结清扫;(5)消化道重建。本文对由外周入路和中间入路发展而来的尾侧联合中间入路进行了简要介绍,该术式技术上可行,术者操作相对简便,手术安全性高,可供结直肠外科医生参考。

The key steps include as following:(1)Abdominal exploration;(2)Right retro-colonic space(RRCS)expansion:Firstly to dissect the natural surgical plane between Toldts fascia and mesocolon.Then to extend the RRCS to the level of colonic hepatic flexure,while exposing the duodenum,which is a sign of entering the retro-colonic space(TRCS).(3)Ligation of the colonic blood vessels by using the medial approach:the ileal colon blood vessels(ICV,ICA)are projected on the surface of the mesentery as anatomical landmarks to dissect the mesocolon,which could be easily merged with the opened RRCS gap behind it.With SMV as the main line,the surgical stem was cleaned,then Henle’s stem and its branches were further dissected.(4)Dissection of pyloric lymph nodes;(5)Reconstruction of the digestive tract.This article gives a brief introduction to the hybrid caudal-medial approach developed from the lateral and medial approach.The procedure is technically feasible,and is relatively simple to operate,which could be used as a reference for colorectal surgeons.