超低位直肠癌保肛术

5孔法,仰卧,取头低足高30°的右侧倾斜膀胱截石位。1探查腹腔。2内侧入路从乙状结肠系膜与盆底腹膜交界处切开,自内向外分离Toldt's间隙。3距腹主动脉0.5 cm处Hem-o-lock断结扎肠系膜下动脉,在近屈氏韧带下方分离出肠系膜下静脉,切断,保护肠系膜下神经丛。4乙状结肠系膜裁剪及游离。5直肠后间隙分离:保护腹下神经丛。6直肠前壁及侧方分离:腹膜返折上0.5~1.0 cm切开,沿邓氏筋膜前分离直肠前壁,精囊腺底部切开邓氏筋膜,侧方分离全程以盆神经作为指引。7直肠末端系膜分离:将直肠系膜从肛提肌裂孔边缘切断,进入括约肌间隙,顺直肠壁向肛侧分离,距肿瘤2 cm切割闭合直肠。切除近端肠管行直肠乙状结肠端端吻合,回肠末端预防性造口。

Anus-preserving surgery for ultra-low rectal cancer

Supine Position and lithotomy position were employed, and patient was placed on, 30°right lateroversion with head lower and feet higher position, by using five-hole method for laparocopic operation.①To explore the abdominal cavity.②Through the medial approach, to dissect from the junction of Sigmoid mesocolon and pelvic peritoneum, separation were carefully performed inside-out along Toldt ’s space.③Ligation of inferior mesenteric artery was made 0.5 cm distal from abdominal aorta by using Hem-o-the lock.Isolation of the inferior mesenteric vein was performed under Treitz ligament ,and to cut off with protection of inferior mesenteric plexus .④To dissect Sigmoid mesocolon for mobilization.⑤Retrorectal space separation:Pay attention to protect Hypogastric Plexus.⑥The anterior lateral separation of rectum:Along Peritoneal flexure to cut 0.5-1.0 cm,and to dissect rectal anterior wall along Denovillier fascia to the bottom of the seminal vesicle gland and guiding lateral separation by pelvic nerve.⑦Distal separation of mesorectum:The mesorectum was dissected at the plane of levator ani muscle in cutting edges,and entering the intermuscular spatium of anal sphincter ,along the rectal wall to the anus,to cut rectum 2cm from the distal margin of tumor.End to end anastomosis of proximal sigmoid colon and distal rectum was made, and preventive terminal ileum colostomy was also made.