腹腔镜辅助全结肠系膜切除的右半结肠根治术

手术路径采用由内向外、自下而上的中间入路。右侧全结肠系膜切除(CME)手术强调间隙的分离和淋巴结的清扫。首先以回结肠血管解剖投影为起点切开腹膜，游离回结肠血管，显露肠系膜上静脉(SMV)远端并进入血管鞘，沿SMV向头侧解剖至胰腺颈部下缘，可逐个定位回结肠血管、右结肠血管和中结肠血管。在SMV前部行整体淋巴结清扫，再进入并由内向外拓展右侧Toldt间隙，显露十二指肠、胰腺头部、SMV的右侧及胃结肠干，最后由外侧分离将右半结肠完全游离，注意保护腹膜后结构。研究表明，CME理论指导下的右半结肠癌根治术可以彻底完成D3淋巴结清扫，并且降低局部复发和远处转移风险，延长总生存期。

Laparoscopic-assisted complete mesocolic excision in radical right hemicolectomy

Complete mesocolic excision of radical right hemicolectomy was performed as following: medial approach was employed and accurate interfacial space and sufficient lymph node dissection was highlighted in this operation. First, peritoneum was dissected along the anatomical position of ileocolic vessels, ileocolic vessels and the distal section of superior mesenteric vein (SMV) were then dissociated. Second, proximal section of SMV was exposed to the inferior margin of pancreas neck. Thereafter, the ileocolic vessels, the middle colic vessels and the right colic vessels were located. Third, after the dissection of lymph nodes along SMV, right Toldt’s fascia space was exposed from inside out. Next, the duodenum, the head of pancreas, the right side of SMV and Henle trunk were exposed. Finally, the right colon was dissociated by lateral procedure. Research indicated that this approach could ensure the D3 lymph node dissection, which was associated with the low local recurrence and distant metastasis, and the significant prolongation of overall survival.