腹腔镜右半结肠癌CME+D3根治术(电铲+Maryland钳)

Laparoscopic right hemicolectomy and D3 lymphadenectomy for right colon cancer

手术入路采用中央入路,沿中线偏右外科干投影的左侧界由尾侧向头侧切开右半结肠系膜根的附着点,沿着回结肠血管下隐窝切开膜桥,进入右半结肠系膜背侧叶与泌尿生殖筋膜之间的筋膜间隙,即所谓的右侧Toldt间隙,以相互贴近的两层筋膜背侧的微血管神经网络为参照物,遵循筋膜解剖原理(即钝性推拨和锐性切开相结合的方法)实现无血化分离,遇到微血管交通支予以电凝切断。D3根治术包括第203、213、2221及或223组淋巴结的清扫,沿着肠系膜上动脉右侧缘神经血管鞘的表面仔细清扫上述淋巴结。

The central approach is usually applied for laparoscopic right hemicolectomy.Firstly,along the left boundary of the projection of the surgical trunk to the right side of the midline,the attachment point of the right mesocolic root was cut from caudalside to cranialside,and the membranous bridge was cut along the inferior recess of ileocolic vessels inorder to enter the fascial space between the dorsal layer of the right mesocolon and the urogenital fascia layer,which is called the right Toldt space.The principle of fascial anatomy(namely,blunt pushing and sharp dissection)should be abided by and was used to achieve bloodless separation,and the communicating branches of micro-vessels were cut off by electronic hook.D3 lymphadenectomy including station 203,213,222l and or 223 lymph nodes.All of the above lymph nodes should be carefully dissected along the surface of neurovascular sheath on the right edge of superior mesenteric artery.