腹腔镜直肠癌根治术(Dixon)

在结肠系膜与后腹膜移行处切开后腹膜，分离系膜至肠系膜下动脉根部，清扫253组淋巴结，在距腹主动脉根部1 cm处夹闭并切断血管，切断肠系膜下静脉。由内侧向外侧分离结肠系膜至结肠旁沟，切开其左侧后腹膜，将降结肠及乙状结肠系膜从后腹壁游离。沿直肠固有筋膜与盆壁筋膜的间隙按照TME原则锐性分离直肠系膜，先游离后壁，再游离两侧壁及前壁，直至盆底。在肿瘤下方2 cm处用阻断夹夹闭肠管，冲洗远端直肠，用切割缝合器切断直肠。取脐部弧形切口。提出近端肠管，于肿瘤近端15 cm处离断肠管。近端置入管型吻合器抵钉座，还纳腹腔，重建气腹。经肛置入管型吻合器，在腹腔镜直视下作乙状结肠－直肠端端吻合，冲洗腹腔，置引流管，手术结束。

Laparoscopic radical resection of rectal cancer (Dixon)

Firstly, to dissect the retroperitoneaum along transitional zone between mesocolon and retroperitoneum, and to separate the mesentery to the root of the inferior mesenteric artery and to dissect 253 group lymph nodes, then to clamp and cut inferior mesenteric vessels 1 cm away from abdominal aorta. Sencondly, to separate mesocolon from medial to lateral to the paracolic sulcus, and to dissect retroperitoneum on the left side for the sufficient mobilization of descending colon and sigmoid colon. Thirdly, to dissect rectal mesentery sharply between proper fascia of rectum and pelvic fascia according to TME principle, from posterior wall to lateral and anterior wall then to pelvic floor. To clamp rectum 2 cm below tumor, and to rinse the distal rectum before cutting it with a stapler. Finally, to make an arc incision around the umbilicus, then to pull out the proximal intestine and to cut colon 15 cm away from the tumor. To place in the anvil of the circular stapler in proximal intestine, and to put it back into abdomen and to rebuild artificial pneumoperitoneum. Then to achieve transanal anastomosis by using circular stapler. then to rinse the abdomen and to put the drainage tube after surgery.