腹腔镜根治性(扩大)右半结肠切除术
|
摘要
手术采取经典的中间入路:沿肠系膜上静脉(SMV)表面切开,于其左侧清扫回结肠动脉、右结肠动脉及中结肠动脉根部淋巴结并切断;在回结肠血管下方2 cm自然皱褶处切开进入小肠系膜根部,清扫SMV右侧淋巴组织,根部切断回结肠静脉;沿十二指肠水平部与胰头表面间隙分离,显示胃结肠静脉干,于根部切断;胃大弯中部血管弓下方进入网膜囊,在距幽门10 cm处横断胃网膜右血管,沿胃大弯侧分离至显露胃网膜右动脉根部;沿胰颈下缘切开横结肠系膜前叶,向右分离至胃网膜右动脉根部,清扫并将其切断,向右清扫胰头与十二指肠降部前方横结肠系膜;从上至下、从内向外完整切除右半结肠系膜后叶。于右侧经腹直肌切口切开腹壁,长约6 cm,将右半结肠拖出体外。在肿瘤远端10~15 cm横断横结肠,在回盲部近端切断15 cm回肠后行回肠横结肠吻合术。
In the medial dissection,the sheath of the SMV was dissected along the distribution of the vessel. Lymphadenectomy was performed at the left side of the SMV and dissected at the roots of the ileocolic artery,right colic artery,and middle colic artery. To expose the root of the small intestine mesentery,an incision was made at 2 cm beneath the natural folds of the ileocolic vessels. The lymph nodes were dissected at the right side of the SMV and the ileocolic vein was ligated. Dissection was made along the space between the pancreatic head and the duodenum,while exposing and ligating at the root of the gastrocolic trunk. The right colon branch of the superior mesenteric vein and the gastrocolic trunk were exposed along with the right side of the superior mesenteric vein. The gastrocolic trunk was ligated and cut,and the area lymph nodes were dissected. The gastrocolic ligament was exposed along the greater curvature from the middle to the distal end,and the right gastroepiploic artery was also exposed and then ligated and cut. According to an inside-to-outside and upside-todownside approach,the right colon and its mesentery were separated completely. A 6 cm abdominal incision was made on the right lower quadrant. The right colon was resected in vitro,including the tumor,the colic mesentery and distal part of the ileum. An extracorporeal functional end-to-end ileo-transverse colon anastomosis was performed via the 6 cm incision. After a drainage tube was placed,the abdominal incision was sutured.
In the medial dissection,the sheath of the SMV was dissected along the distribution of the vessel. Lymphadenectomy was performed at the left side of the SMV and dissected at the roots of the ileocolic artery,right colic artery,and middle colic artery. To expose the root of the small intestine mesentery,an incision was made at 2 cm beneath the natural folds of the ileocolic vessels. The lymph nodes were dissected at the right side of the SMV and the ileocolic vein was ligated. Dissection was made along the space between the pancreatic head and the duodenum,while exposing and ligating at the root of the gastrocolic trunk. The right colon branch of the superior mesenteric vein and the gastrocolic trunk were exposed along with the right side of the superior mesenteric vein. The gastrocolic trunk was ligated and cut,and the area lymph nodes were dissected. The gastrocolic ligament was exposed along the greater curvature from the middle to the distal end,and the right gastroepiploic artery was also exposed and then ligated and cut. According to an inside-to-outside and upside-todownside approach,the right colon and its mesentery were separated completely. A 6 cm abdominal incision was made on the right lower quadrant. The right colon was resected in vitro,including the tumor,the colic mesentery and distal part of the ileum. An extracorporeal functional end-to-end ileo-transverse colon anastomosis was performed via the 6 cm incision. After a drainage tube was placed,the abdominal incision was sutured.
引文