腹腔镜下往复式右半结肠D3/CME根治术

目的随着腹腔镜右半结肠D3/CME根治手术逐渐成为发展趋势，为更好克服D3根治术SMV前方淋巴结清扫的困境，本文介绍一种易于操作的往复式推进术式。 方法该新手术方式具有下列2个特点：自尾侧向头侧多次往复式分离并以胰腺颈部下缘为终点，先于左侧缘显露SMV全长再处理静脉属支。回顾2012~2015年采用本方法的58例患者术中术后指标，评估其安全性及可行性。 结果2例患者因腹腔粘连中转，余58例患者均顺利完成手术，手术时间164±28.3 min，出血量64±63.5 ml，清扫淋巴结数目28±13.9个，术后无严重并发症及围手术期死亡。 结论腹腔镜下往复式右半结肠D3/CME根治术时简单、安全且可行的，为解决SMV静脉属支变异带来的手术困难提供了更安全的新的手术入路方式。

Unidirectionally proceding and pancreas-oriented procedure for laparoscopic radical right hemicolectomy with D3 lymphadenectomy

ObjectiveTo facilitate laparoscopic D3/CME right hemicolectomy, here we introduce an unidirectionally proceding and pancreas-oriented procedure for laparoscopic radical right hemicolectomy with D3 lymphadenectomy. MethodsThis novel approach of D3 hemicolectomy is characterized by the following two features: series of repeated unidirctionally preceding dissection along SMV starting caudally and ending at the lower edge of pancreatic neck, and identifying the left 1/3 aspect of the whole length of SMV firstly followed by ligation of individual colonic veins. From Jan 2012 to Dec 2015, 58 patients but 2 underwent this procedure successfully. ResultsThe operation time was 164±28.3 min, blood loss was 64±63.5 ml, retrieved lymph nodes were 28±13.9, no mortality and major mobidity were observed. ConclusionsThis novel unidirectionally proceding and pancreas-oriented procedure for laparoscopic radical right hemicolectomy with D3 lymphadenectomy is safe and feasible, with the merit of providing an easier and safer way of managing the frequent variations of tributaries of SMV.