腹腔镜右半结肠根治性切除术

患者取仰卧分腿位,扶镜手站在患者两腿之间,术者站在患者左侧,助手站在患者右侧。腹腔镜观察孔位于脐下10 cm。首先,腹腔镜探查肝脏及腹盆腔,没有发现明确转移灶。先沿Toldt’s线打开升结肠侧方解剖间隙,游离回盲部,以利于更好地牵拉右半结肠。随后,打开回结肠血管与肠系膜下血管之间的系膜,显露肠系膜下静脉,并以此作为标志,自下向上、自中间向右侧进一步解剖并扩大手术平面。良好的游离后,首先分离、夹闭并切断回结肠静脉和动脉,随后处理右结肠血管和结肠中血管,此过程中清扫胰腺前方淋巴脂肪组织。因为肿瘤位于结肠肝曲,我们将幽门下区淋巴结一并切除。完成游离后,脐上方取6 cm纵行切口,将病变肠管提出腹腔外完成切除和回结肠端侧吻合。术后病理回报:p T4b N2b M0(Ⅲc期)。患者恢复顺利,术后第8天出院。

Laparoscopic radical right hemicolectomy

The patient was placed at supine position,while operation surgeon on left,assistant surgeon on right and assistant surgeon between legs of patient.The laparoscopy trocar hole was made 10 cm below umbilicus.Firstly the exploration of the abdominal and pelvic cavity were performed to ensure no metastasis.Then,cecum was dissected and mobilized along Toldt's line and between ascending colon and Gerota fascia.Secondly,the mesentery of ascending colon were dissected to expose the superior mesenteric vein(SMV).The dissection was continued by using middle approach.The ileocecal vein and artery,right colic vessels and the middle colic vessels were clipped and cut respectively.The No.6 group lymphnodes of the stomach were also removed for the specific radical resection of the hepatic flexure colon cancer.Finally,the specimen was removed from an 6 cm incision above the umbilicus and the end to side ileocolostomy was performed.The postoperative pathological result was T4bN2bM0(IIIc stage).The patient was discharged at the 8th postoperative day.