探讨联合中间入路在腹腔镜左半结肠癌根治术中的可行性与安全性。

回顾性分析2015年6月至2018年12月间山东大学附属济南市中心医院胃肠外一科实施的42例联合中间入路腹腔镜左半结肠癌根治术病例的临床资料及相关手术视频图片资料。联合中间入路是首先采用中间入路处理降乙结肠系膜根部，然后采用头侧入路处理横结肠左半系膜根部及卸脾曲。

纳入本研究的患者均以联合中间入路完成腹腔镜左半结肠癌根治术，手术达到根部处理肿瘤主要供血动脉及从正确解剖平面安全游离脾曲，并发现副结肠中动脉8例。手术平均时间（127.2±15.8）min，平均出血量（30.0±25.4）mL，术中未出现胰腺及脾损伤，淋巴结清扫数目平均（18.4±3.6）枚/例，术后并发症3例，全组未出现吻合口漏。

联合中间入路应用于腹腔镜左半结肠癌根治术中，比较容易进入正确解剖平面及发现变异副结肠中动脉，手术是安全可行的，近期疗效满意。

To investigate the feasibility and safety of the hybrid medial approach (HMA) for the laparoscopic radical left hemicolectomy.

Clinical data including the surgical videos and photos of 42 patients were analyzed, who underwent the laparoscopic radical left hemicolectomy using the HMA in the Department of Gastrointestinal Surgery of Jinan Central Hospital Affiliated to Shandong University, from June 2015 to December 2018. The HMA describes the surgical strategy that firstly divides the left mesocolon from the mesenteric root (the medial approach), and then divides the left part of the transverse mesocolon from the mesenteric root in the cephalad-caudad direction, as well as mobilize the splenic flexure.

All the patients in this study completed laparoscopic left hemicolon cancer radical operation by combining the middle approach. The main blood supply arteries of the tumor were treated at the root and the splenic flexure was free from the correct anatomic plane. The average time of operation was (127.2±15.8) min, the average amount of bleeding was (30.0±25.4) mL, there was no injury of pancreas and spleen during operation, the average number of lymph node dissection was (18.4±3.6) per case, the postoperative complications were 3 cases, there was no anastomotic leakage in the whole group.

The HMA may facilitate the access into the correct anatomical plane during the laparoscopic radical left hemicolectomy and aid in the identification of the aberrant accessory middle colic arteries. The approach is safe, feasible, and with satisfactory short-term outcomes.