腹腔镜右半结肠切除术

术中纤维结肠镜业甲蓝染色定位,肿瘤位于结肠肝区,将大网膜和横结肠推向头侧,小肠推向左侧腹腔,暴露肠系膜根部,提起回盲部,沿肠系膜上静脉方向超声刀剪开后腹膜,分别于根部结扎回结肠动静脉和右结肠动静脉,同时清扫血管根部淋巴结.于结扎血管处进入Toldt间隙,暴露并切断胃网膜右血管,清扫幽门下方淋巴结.沿结肠外侧自髂窝至结肠肝曲,切开后腹膜,将升结肠从腹后壁游离,右下腹取7 cm切口,保护切口.体外切除右半结肠包括肿瘤、结肠系膜和足够的肠段（回肠末段、盲肠、升结肠和右半横结肠）.回肠横结肠端侧吻合.缝合横结肠系膜与回肠系膜的系膜裂口 放置引流,查无出血后,关腹.

Laparoscopic right colectomy

Colmoscopy was used to determine the location of tumor.The tumor was in the hepatic flexure of the colon and was marked with methylene blue.Exposure of the root of mesentery by moving the colic omentum and transverse colon to head side and.the small bowel to left side of the belly,along the direction of the superior mesenteric vein to cut the retroperitoneal by using an ultrasonic scalpel.In the root of the vasculature,ileocolic and right colon vessels were ligated and cut respectively,and the lymph nodes were dissected.Through the Toldt gap,right gastroepiploic vessels were exposed and cut,and lymph nodes below the pylorus were dissected.From the iliac fossa to the hepatic flexure of the colon,the peritoneum was cut and the ascending colon was dissected.A 7 cm abdominal incision was made on the right lower quadrant.Right colon resection was performed in vitro,including the tumor,colorectal mesentery and distal part of the ileum.End-to-side anastomosis of the ileum and transverse colon was performed.The mesenteric hiatus of the ileum and transverse colon was closed,and a drainage tube was placed thereafter.Finally,the abdominal incision was sutured after no bleeding was observed.