腹腔镜辅助中央入路根治性右半结肠切除术

患者全身麻醉后，5孔法建立气腹，术者左侧站位。探查腹腔未见转移，行腹腔镜辅助中央入路根治性右半结肠切除术。手术步骤：充分显露右半结肠系膜，辨认回结肠血管，沿肠系膜上静脉投影切开右半结肠系膜根部，进入Toldt’s间隙。分离显露回结肠血管并清扫淋巴结，进而显露肠系膜上静脉。向头侧拓展显露肠系膜上静脉并清扫血管根部淋巴结。显露右结肠、中结肠血管，清扫其根部淋巴结。结扎离断回结肠血管、右结肠血管及中结肠血管右支。向头侧及外侧拓展Toldt’s间隙，分离回肠系膜根部，最后从外侧游离升结肠与内侧贯通，完成右半结肠游离。修整回肠，距回盲部10 cm离断血管弓。采用5 cm上腹正中辅助切口，完成回肠-横结肠端侧吻合并移除标本。

Laparoscopic-assisted central approach radical right hemicolectomy

After the patient was anesthetized，pneumoperitoneum was established by the 5-hole method，and the surgeon was left sided. No metastases were found in the abdominal cavity，then the laparoscopic-assisted central approach radical right hemicolectomy was performed. Surgical steps：after fully expose the right mesentery and identify the ileocolonic vessels，incise the root of the right mesentery along the projection of the superior mesenteric vein，entering the Toldt’s space. The ileocolic vessels were isolated and the lymph nodes were dissected. The superior mesenteric vein was exposed and the lymph nodes at the root of the vessel were dissected. The right colon vessel and the middle colon vessel were exposed，and the lymph nodes were dissected. The ileocolonic vessels，the right colonic vessels and the right branch of the middle colonic vessels were ligated and transected. The Toldt’s space was expanded from the lateral side and connected to the medial side to complete the dissociation of the right colon. The ileum vascular arch was transected 10 cm from the ileocecal region. The ileum-transverse colon end-to-side anastomosis was completed by a 5cm assisted incision and at last，the specimen was removed.