内侧入路行右半结肠癌D3根治术

目的探讨内侧入路行右半结肠D3根治术的方法及临床应用价值。方法对18例右侧结肠癌患者行内侧入路的右半结肠癌D3根治术。手术游离肠系膜上静脉外科干,根部结扎肠系膜血管,清扫N3淋巴结,完整切除Toldt筋膜及胰头十二指肠前筋膜,由内向外整块切除右半结肠和肿瘤,结肠肝曲癌行右半结肠癌扩大根治术。结果所有患者手术均顺利完成,手术时间120～210分钟,平均182.5分钟;术中出血90～240mL,平均160mL;淋巴结清扫总数16～36枚,平均28枚,其中N3淋巴结转移6例;术后住院时间5～16天,平均9天;术后肠道功能恢复延迟2例,无外科死亡病例。结论内侧入路的右半结肠癌D3根治术是减少肿瘤复发的有效术式,且更加符合无瘤原则。

Medial to lateral approach of D3 lymphadenectomy for right-sided colon cancer

Objective To evaluate the efficacy of D3 lymphadenectomy using the medial to lateral(MtL)approach for right-sided colon cancers.Methods A total of 18 cases underwent right hemicoloectomy with D3 lymphadenectomy from March 2005 to July 2009.The superior mesenteric vein surgical trunks were dissociated and the mesenteric vessels were ligated at the root.The lymph nodes along the surgical trunk at the root of the superior mesenteric vessels were dissected.Then the Toldt's fascia and the anteior fascia of pacre...