摘要
中央入路于乙状结肠系膜内侧切开后腹膜，解剖Toldt’ s间隙，分别向左、向尾侧、向头侧进一步游离、扩大该间隙，显露并注意保护左侧输尿管、左侧生殖血管。充分游离Toldt ’ s间隙后，放入小纱布以作标记。提起肠系膜下血管根部系膜组织，彻底分离清扫肠系膜下动脉根部淋巴脂肪组织。夹闭、切断肠系膜下动脉，注意保护生殖神经。向下游离，首先游离后方的直肠后间隙和前方的邓氏间隙，然后离断直肠侧韧带。最后按腹腔镜下全直肠系膜切除法＋双吻合器法切除直肠肿瘤及重建肠道。
Abstract
With a middle approach ,the medial side of the sigmoid mesocolon was dissected for the exposure of Toldt ’ s space.The operation goes leftwards , tail-and head-wards respectively , exposes and protects the left ureter and reproductive vascullature .After exposure of Toldt ’ s space, a piece of gauze was inserted for marking .To lift roots of the inferior mesenteric vessels , lymphatic adipose tissues were dissected and cleansed completely .Then the inferior mesenteric artery was clipped and cut off , while protecting the reproductive nerves.At first, the posterior gap and Denovillier fascia were dissected ,and then the lateral rectal ligament was resected .The rest steps are similar to laparoscopic total mesorectal excision +double stapling, resection of rectal tumor , and reconstruction of the intestinal tract .
NETL
NSTL
维普
万方数据