腹腔镜右半结肠癌根治术难点与关键技术

随着腹腔镜右侧完整全结肠系膜切除(CME)治疗右半结肠癌的推广,右半结肠癌患者从中普遍获益。从传统的外侧入路到如今的中间入路,从开放手术到腹腔镜手术,手术操作不断精细化、规范化。临床实践中,右侧CME手术强调间隙的分离和淋巴结的清扫,掌握术中操作的难点与技巧可以达到事半功倍的效果。本文从肠系膜上血管的解剖和淋巴结的清扫、胰头前方肠系膜上静脉属支血管的解剖和出血的预防和处理、吻合口并发症的预防和处理、肠管切除重建系膜孔的处理这四个方面展开论述,望对读者有所裨益。

Difficulties and surgical techniques of laparoscopic right hemicolectomy for right colon cancer

With the introduction and popularization of complete mesocolic excision(CME)for the surgical treatment of right colon cancer,patients have received a lot of benefit.From traditional lateral approach to present medial approach,from open surgery to laparoscopic surgery,surgeons have made their surgeries more accurate and more precise.From a clinical point of view,finding the correct plane and sufficient lymph node dissection are of vital importance in CME for right colon cancer.It is helpful for trainees to master the skill and techniques.This article focuses on the following four aspects: 1.Anatomy of superior mesenteric vessels and lymph node dissection.2.Anatomy of branches of SMV in the anterior aspect of pancreas and the prevention and treatment of heamorrage.3.Prevention and treatment of anastomotic complications.4.Management of mesangial hiatus.Hoping it would be benefit for readers.