腹腔镜右半结肠癌根治术

以肠系膜上静脉外科干为中心的D3淋巴结清扫是腹腔镜右半结肠癌根治术的关键操作。手术径路采用由内向外、自下而上的内侧入路，首先以回结肠血管解剖投影为起点，游离回结肠血管，显露肠系膜上静脉远端并进入血管鞘，沿其左侧向上至胰腺颈部下缘，以确定淋巴清扫的平面，并离断处理右结肠动脉和中结肠血管，再进入并由内向外拓展天然外科平面-右侧Toldt 间隙，轻松显露十二指肠、胰腺头部、肠系膜上静脉的右侧，同时沿上静脉右侧壁处理可能的属支及胃结肠干，最后由外侧分离将右半结肠完全游离。这种内侧入路可以清楚地判断血管的变异，彻底完成D3淋巴结的清扫，明显提高手术安全性，并达到根治目的。

Laparoscopic-assisted radical right hemicolectomy

D3 lymph node dissection around the surgical trunk of the superior mesenteric vein is the key operative procedure of laparoscopic-assisted radical right hemicolectomy .Medial approach is adopted , from inside to outside and from downside to upside .Firstly, it is started with the anatomic projection of ileocolic vessels, dissecting the distal superior mesenteric vein from ileocolic vessels and accessing into the vascular sheath plane , along with which lymph nodes are dissected up to the inferior margin of the pancreatic neck, then dividing and disposing the right colic artery and middle colic vessels .After that, the further step is accessing into the natural surgical plane-right Toldt ’ s space , to expose the duodenum , pancreatic head and the right side of the superior mesenteric vein .Simultaneously , disposing the probable branches of the superior mesenteric vein and the gastrocolic trunk along with the right side of the superior mesenteric vein . Finally, it is necessary to separate the right colon completely from the outer laterally .By the medial approach, it could ensure a clear judge the variation of vessels and a complete D 3 dissection of lymph nodes , which could achieve a radical resection and significantly improve the surgical safety .