腹腔镜辅助右半结肠癌根治切除术

采用中间入路五孔法。沿肠系膜上静脉(SMV)表面用超声刀切开后腹膜,暴露SMV。紧贴SMV主干离断回结肠动静脉,在右结肠动脉根部将其结扎切断。游离出结肠中动静脉脉主干、Henle’干、副右结肠静脉(SRCV)和胃网膜右静脉(RGEV)。结扎切断结肠中动静脉右支,解剖出胃网膜右动脉(RGEA),胰头前切开横结肠系膜前叶进入小网膜囊。依次在根部结扎切断SRCV、RGEV及RGEA。沿Todlt’间隙将右半结肠系膜掀向右侧腹,切断部分回肠系膜,沿右结肠旁沟切开侧腹膜。切断胃结肠韧带,清除第6组淋巴结。切断肝结肠韧带,完全游离右半结肠,在右中腹做小切口行标本切除及吻合。

Laparoscopy-assisted right hemicolon radical resection

Five-holes method and medial-to-Lateral approach was performed in this operation.The posterior peritoneum was dissected with ultrasound knife to expose super mesenteric vein (SMV) .Close to SMV, ileocolic vein vessels and right colon artery were mobilized and were ligated and cut off at their root respectively.Middle colic vessel, Henle’s trunk, superior right colon vein (SRCV) and right gastroepiploric vein (RGEV) were dissected respectively, thereafter right branch of middle colic vessel were ligated and cut off.Right gastroepiploric artery (RGEA) was also moblized.In the front of pancreatic head, the anterior lobe of transverse mesocolon was dissected and lesser peritoneum sac was exposed.SRCV,RGEV and RGEA were successively ligated and cut off at their root . Right colic mesentery was expanded to the right lateral peritoneum along the Todlt ’ s space.Then to cut off the mesentery of ileum and the lateral peritoneum of right colon.To dissect the gastrocolic ligament and swept NO.6 lymph node.Finally,to cut off heptocolic ligament and right colon were thoroughly freed out, while specimen was removed and ileotransversostomy was made through mini-right abdominal incision.