腹腔镜扩大左半结肠切除术

采用5孔法，经典中间入路。在右侧输尿管内侧2 cm切开，进入左侧Toldt间隙，自尾侧向头侧锐性分离，清扫肠系膜下动脉根部的淋巴脂肪组织。解剖降结肠及乙状结肠动脉，根部离断。十二指肠空肠曲左侧离断肠系膜下静脉根部，向外侧拓展降结肠后间隙、乙状结肠后间隙和直肠上段后间隙，确认左输尿管及生殖血管以防止损伤。切开并游离横结肠系膜，在胰颈下缘显露中结肠动静脉，于根部离断。沿降结肠沟剪开左侧腹膜，上至脾曲，下至直肠上段，与之前已拓展完成的左结肠后间隙汇合。自胃大弯侧血管弓内离断血管分支，直至根部切断胃网膜左血管，并切断脾结肠韧带，完全游离脾曲。于左侧经腹直肌切口切开腹壁，长约5 cm，将左半结肠拖出体外。在肿瘤近远端10～15 cm横断结肠，行端端吻合术。

Laparoscopic extended left hemicolectomy

We used the conventional medial approach with five-port to perform laparoscopic total mesorectal excision. In the medial dissection, an incision was made at 2 cm on the inside of the ureter and the left Toldt space was entered and expanded from the caudal to the cephalicl end by sharp dissection. In this process, lymphadenectomy was performed at the root of the inferior mesenteric artery. Meanwhile, the roots of the left colic artery and the sigmoid artery were exposed and dissected. The root of the inferior mesenteric vein was ligated and cut at the left side of the ligament of Treitz. According to an inside-to-outside approach, we further expanded the left retrocolic space and the retro-rectosigmoid space. The process must be careful to protect left ureter and reproductive artery against injury. Dissection was made along the mesocolon transversum, while exposing and ligating at the root of the middle colic artery at the lower edge of the pancreatic head. The gastrocolic ligament was exposed along the greater curvature from the middle to the distal end, and the left gastroepiploic artery was also exposed and then ligated and cut. Finally, the left colon and its mesentery were separated completely. A 5 cm abdominal incision was made on the left lower quadrant. The left colon was resected in vitro, including the tumor, the colic mesentery and the proximal and distal part of the colon. An extracorporeal functional end-to-end colon anastomosis was performed via the 5 cm incision. After a drainage tube was placed, the abdominal incision was sutured.