优先清扫No.206和No.204组淋巴结的全程无结扎结肠肝曲癌根治术

Ligation-free radical resection of colon cancer in hepatic flexure with priority dissection of No.206 and No.204 lymph nodes

本文首次报道以头侧入路优先清扫No.206和No.204组淋巴结的结肠肝曲癌根治术。首先,使用LigaSure(LF1937)将胃网膜右系膜连同右结肠及其系膜向尾侧剥离,显露十二指肠降部外侧的Toldt筋膜平面,以及胰十二指肠前筋膜平面和Henle干汇入肠系膜上静脉处;其次,沿着回结肠血管蒂下窝切开回结肠系膜表面的膜桥,在右结肠系膜背侧叶与Toldt筋膜之间向头侧拓展筋膜间隙并与头侧间隙会师;最后,在肠系膜上动脉右侧缘剥离右结肠系膜,运用LigaSure(LF1937)防波堤技术,凝闭并切断回结肠动静脉、右结肠动静脉及中结肠动静脉,清扫No.203、No.213和No.223组淋巴结。

This is the first report about Ligation-free radical resection of colon cancer in hepatic flexure with priority dissection of No.206 and No.204 lymph nodes.Firstly,LigaSure(LF1937)forceps was used to peel off the right gastroepiploic mesentery with the right hemi-colon and its mesentery from the cranial side to the caudal side,and to expose the right Toldt's fascia plane.Therefore,the anterior fascial plane of the pancreaticoduodenum and the confluence of the Henle trunk into the superior mesenteric vein are revealed clearly.Secondly,the membrane bridge on the surface of the ileo-mesocolon was incised along the infravascular fossa of the ileocolon.The fascial space was extended between the dorsal layer of the right mesocolon and the right Toldt's fascia,then converged the cranial side of the Toldt's fascial space.The right mesocolon was peeled off at the right edge of the superior mesenteric artery,and the breakwater technique of LigaSure(LF1937)was applied to coagulate and transect vessels as followed:the ileocolic vessels,the right colic vessels,and the middle colic vessels.Meanwhile,the No.203,No.213 and No.223 groups of lymph nodes are dssected sequentially.