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中华结直肠疾病电子杂志 ›› 2017, Vol. 06 ›› Issue (04) : 284 -289. doi: 10.3877/cma.j.issn.2095-3224.2017.04.004

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左半结肠切除术的争议和基于膜解剖的脾曲游离技巧
池畔1,(), 王枭杰1   
  1. 1. 350001 福州,福建医科大学附属协和医院结直肠外科
  • 收稿日期:2017-05-11 出版日期:2017-08-25
  • 通信作者: 池畔
  • 基金资助:
    国家临床重点专科建设资助项目(卫办医政函(2012)649号); 福建医科大学启航基金项目(No.2016QH027)

The controversy of left hemicolectomy and the key technology of mobilization of the splenic flexure basing membrane anatomical theory

Pan Chi1,(), Xiaojie Wang1   

  1. 1. Department of Colorectal Surgery, Union Hospital, Fujian Medical University, Fuzhou 350001, China
  • Received:2017-05-11 Published:2017-08-25
  • Corresponding author: Pan Chi
  • About author:
    Corresponding author: Chi Pan, Email:
引用本文:

池畔, 王枭杰. 左半结肠切除术的争议和基于膜解剖的脾曲游离技巧[J]. 中华结直肠疾病电子杂志, 2017, 06(04): 284-289.

Pan Chi, Xiaojie Wang. The controversy of left hemicolectomy and the key technology of mobilization of the splenic flexure basing membrane anatomical theory[J]. Chinese Journal of Colorectal Diseases(Electronic Edition), 2017, 06(04): 284-289.

左半结肠切除术主要适用于横结肠近脾曲癌、降结肠癌和乙状结肠癌。对于左半结肠癌根治术的具体肠段切除范围、区域淋巴结清扫范围目前尚存在争议。在全结肠系膜切除时代,目前尚缺乏专门针对左半结肠癌具体肠段切除范围及淋巴结清扫范围的前瞻性随机对照研究。另一方面,由于结肠脾曲的筋膜、系膜关系复杂,对结肠脾曲的游离一直是腹腔镜手术的主要难点与研究热点。本文拟从以上方面进行讨论。并结合笔者经验,介绍基于膜解剖理论的脾曲游离方法。

Left hemicolectomy is indicated for patients with transverse colon cancer at splenic flexure, descending colon cancer and sigmoid colon cancer. No standard management policy as to the exact length of the colonic resection and extent of lymph node excision has emerged to date. In era of recent developments in surgical concept of complete mesocolic excision for colon cancer, no randomized trial to date is available that examines the standard colonic reseciton length and extent of lymph node excision. In addition, laparoscopic mobilization of the splenic flexure is a difficult procedure because of complexity of fascial anatomy regarding this surgical area. We aim to discuss these issues basing membrane anatomy.

图1 左半结肠癌各种术式图示
图4 A图:副左结肠动脉行走路径[13];B图:吲哚菁绿示踪LACCA的淋巴流向[12]
图5 吲哚菁绿示踪IMV根部淋巴结回流的两条路径[12]
图6 脾曲游离的3种主要入路。A图:中间入路;B图:外侧入路;C图:前方入路[17]
图7 胚胎时期大网膜与横结肠系膜腹侧叶的融合过程
图9 第1次进入网膜囊3层膜结构的术中图示
图11 三次进入网膜囊膜解剖图示
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