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传统左半结肠癌根治术需切除包括肠系膜下动脉根部和整个左半结肠。临床上切除肿瘤以上15cm、肿瘤以下10cm肠管已能达到肿瘤切除目的,为保证淋巴结廓清和保留肠段血供,我们自1989年以来采用改良的操作方法,取得较好效果,介绍如下。操作方法:以乙状结肠癌根治术为例。常规结扎肿瘤两端肠管。切开结肠外侧腹膜,按常规游离结肠脾曲,并将该部肠管和系膜向内下以钝性和锐性分离,在脊柱左侧,结肠系膜至胰腺下缘间找到肠系膜下静脉,给予结扎切断。然后将整个左半结肠及系膜向内分离至腹主动脉右侧,此时左半结肠血管及淋巴组织均在这块翻起的后腹膜组织中。分离时注意认清并保护好输尿管。再从髂总动脉分叉处开始,将已翻起之后腹膜
Traditional left colon cancer resection needs to include the inferior mesenteric artery root and the entire left colon. Clinically, 15 cm above the tumor and 10 cm below the tumor can achieve the purpose of tumor resection. To ensure clearance of the lymph nodes and preserve the blood supply of the intestine, we have adopted improved methods of operation since 1989 and achieved good results. Operation method: Take sigmoid colon cancer as an example. Routine ligation of the tumor at both ends of the intestine. The peritoneum of the colon was incised, and the colonic splenic flexure was routinely removed. The intestine and mesentery were separated bluntly and sharply. The inferior mesenteric vein was found between the left side of the spine and the lower edge of the pancreas. Ligation cut off. The entire left colon and the mesangium are then inwardly isolated to the right side of the abdominal aorta. At this time, the left hemi-colonial blood vessels and lymphoid tissues are in this turned-up retroperitoneal tissue. Take care to recognize and protect the ureter when it is separated. From the bifurcation of the common iliac artery, the peritoneum