腹腔镜横结肠癌根治术

Trocar分布采用五孔法,助手向上牵拉横结肠,沿回结肠血管上方横行切开肠系膜血管表面腹膜,分别显露肠系膜上静脉和肠系膜上动脉,分离结肠中动脉,清扫NO.223淋巴结后于结肠中动脉根部结扎切断,向上分离至胰颈水平,根部结扎切断结肠中静脉,分离显露Henle干及其属支,切断右结肠静脉和网膜右静脉,拓展横结肠后胰十二指肠前间隙,三路包抄游离脾曲,注意保留肠系膜下静脉,肿瘤两端各10 cm确定肠管及胃网膜弓切除范围,清扫NO.204和NO.206淋巴结,游离肝曲。绕脐纵切口取出标本,两断端以直线切割闭合器完成侧侧吻合。

Laparoscopic radical transverse colectomy

Five ports placement was employed.Transverse colon was retracted cranially by the assistant surgeon.The peritoneum was incised at the cranial side of the ileocolic pedicle,and transverse incision was made alongside the ileocolic pedicle.Superior mesenteric vein and artery were exposed respectively.The middle colic artery was separated,and then No.223 lymph nodes dissection was done followed by the ligation of middle colic artery at its root.Upward dissection of the peritoneum above the SMV was performed until meeting the neck of pancreas.During this upward dissection,the middle colic vein was ligated and cut at its root,and the Henle trunk and its branches were exposed,with the ligation of right colic vein and right gastro-omental vein.The prepancreaticduodenal space was extended behind the transverse colon.The splenic flexure was mobilized from 3 directions,and the inferior mesenteric vein was preserved.10cm from tumor proximally and distally was identified,and the removal extension of the gastro-omental artery was measured with the dissection of No.204 and No.206 lymph nodes.Then the hepatic flexure was mobilized.Umbilical port was extended vertically for specimen harvest and the proximal and distal colon segments were reconstructed extracorporeally with functional end-to-end anastomosis by linear stapler.