以胰腺为导向的腹腔镜下结肠脾曲游离技术

摘要

目的探讨以胰腺为导向的腹腔镜下结肠脾曲游离技术的可行性及解剖学特点。方法选取2014年9月至2015年5月广东省中医院胃肠外科施行的以胰腺为导向的腹腔镜下左半结肠切除术12例，病例均为左半结肠癌，对结肠脾曲游离有关步骤和解剖学特点予以总结。结果所有患者手术顺利，结肠脾曲游离容易且安全。术中见连着于胰体尾后下缘及脾静脉近端的系膜为左结肠系膜固有筋膜，而非横结肠系膜。切开横结肠系膜后叶拓展胰腺前间隙后，可完全游离胰体尾前方结构，左结肠系膜固有筋膜呈幕帘状悬吊于脾静脉近端及胰体尾后下缘，切开该系膜，根部结扎切断肠系膜下静脉，进入左侧Toldt 间隙。中间入路肠系膜下动脉根部结扎切断，拓展 Toldt间隙并与左上方间隙会师。外侧入路游离脾曲时见左膈结肠韧带及脾结肠韧带已幕帘化，使结肠脾曲游离难度降低。结论以胰腺为导向的腹腔镜下结肠脾曲游离技术可有效解决结肠脾曲游离困难的问题。%Objective To investigate the feasibility and anatomical features of pancreas-oriented mobolization technology of colon splenic flexure in laparoscopic left colectomy. Methods From September 2014 to May 2015 , laparoscopic pancreas-oriented mobolization technology of colon splenic flexure was performed on 12 left hemicolon cancer patients in our department. The surgical procedure and anatomical features were analyzed and summarized. Results All operations were performed successfully with easy and safe mobilization of colon splenic flexure. With retraction of transverse mesocolon , a transverse incision, access to anterior space of pancreas , dissection of pancreatic body and tail were performed. The left mesocolon fascia propria adhering to the lower edge of pancreatic body and tail and proximal part of splenic vein was cut off , inferior mesenteric vein was divided and ligated , easy access to upper-left Todlt gap was extended. Medial approach was adopted , inferior mensenteric artery was ligated , then Todlt gap was further extended and converged. After left lateral dissection of colon splenic flexure with phrenicocolic and splenocolic ligaments suspended like a curtain , colon splenic flexure was finally mobilized easily and safely.