腹腔镜直肠癌低位前切除术

腹腔镜直肠癌低位前切除术。术中首先经中间入路打开乙状结肠系膜内侧浆膜,循Toldt’s间隙向头侧游离至肠系膜下动脉根部,夹闭离断肠系膜下动脉,并清扫253组淋巴结;继续向外侧、尾侧游离左侧Toldt’s间隙,并向下延续至直肠后间隙,分离过程中注意保护左侧输尿管、左侧生殖血管。沿左结肠旁沟打开结肠系膜与侧腹壁的融合筋膜,向上游离左侧结肠至脾曲。向下继续沿直肠后间隙分离,并向两侧拓展;前方在腹膜返折略上水平打开腹膜,在邓氏筋膜前间隙向下游离,从前、后及两侧交替游离并完整切除直肠系膜;双吻合器法切除直肠肿瘤及重建肠道。

Laparoscopic anterior resection of low rectal cancer

Firstly left mesocolon was dissected through medial approach .ThenToldt ’ s space was identified and expanded upwards to the root of inferior mesenteric artery , which was highly ligated and cutted while NO.253 lymph nodes were dissected as well .Then Toldt ’ s space was continuely expanded laterally and downwards to rectal posterior space .The left ureter and reproductive vessels were carefully preserved during dissection .fusion fascia of mesocolon and lateral abdominal wall was dissected along left paracolic sulci, upwards to splenic flexure and downwards to rectal posterior space with transversal expansion .Total mesorectum was dissected and excised through careful separation of Denovillier fasia . Double stapler approach was employed for tumor resection and the reconstruction of intestinal tract .