完全腹腔镜右半结肠癌扩大根治术

在全麻下行完全腹腔镜右半结肠癌扩大根治术:先行腹腔探查,沿肠系膜上动脉左侧打开右结肠系膜,清扫回结肠血管根部淋巴结,进入toldt间隙,显露胰头。分别裸化离断右结肠动静脉、结肠中动静脉的右支,显露肠系膜上静脉的Henle干,裸化离断胃网膜右动静脉。然后血管弓内打开胃结肠韧带,用腔镜切割闭合器离断横结肠;游离回盲部,距回盲部20 cm离断回肠。最后腔镜下将回肠与横结肠行overlap吻合,用倒刺线关闭共同开口及系膜裂孔。手术顺利,历时160 min,术中出血约5 ml。患者术后恢复良好,未出现术后并发症,术后第7天出院。术后病理分期示:T4a N0M0。

Totally laparoscopic extended radical resection for right colon cancer

Under general anesthesia,the patient underwent a totally laparoscopic extended right hemicolectomy.Operating procedures included: firstly,after abdominal exploration,right mesentery was dissected upwards along the left side of superior mesenteric artery,the root of ileocolon vascular was exposed to sweep lymph nodes and to extend toldt's space.The right colon vessels,the right branch of the middle colon artery,Henle's trunk of the superior mesenteric vein and right gastroepiploic vessels were naked and cut respectively.Secondly,the ligamentum gastrocolicum was cut off within the hemal arch,and the transverse colon was cut by using Endo-GIA.Ileocecal region was mobilized and the distal ileum was cut 20 cm from ileocecal junction.Finally,overlap anastomosis of ileum and colon was performed,thereafter common stoma and mesangial hiatus was closed by using STRATAFIX.The operation was successful,which lasted 160 minutes,and the intraoperative bleeding was about 5 ml.Patients recovered well postoperatively with no postoperative complications.Patient was discharged 7 days after surgery.Postoperative pathologic staging was pT4aN0M0.