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腹腔镜下大肠癌手术

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腹腔镜下大肠手术第一书
Content Description

《腹腔镜下大肠癌手术》共分为7个章节,涵盖了腹腔镜下大肠癌手术的所有术式。每一章节都从组织学发生、筋膜血管解剖、手术基本步骤等方面做了图文并茂的阐述,内容全面,重点突出。我们认为本书的最大特色在于它的插图都是基于精准解剖绘制的,非常形象生动,一目了然。是大肠外科医师掌握腹腔镜技术的不可多得的好参考书。本书不仅适合从腹腔镜下大肠癌手术起步学起的中青年医生,对那些在腹腔镜下大肠手术方面已经有丰富经验的专家来说也是一次提升和再学习的机会。
Author Description

三毛牧夫,日本龟田总医院外科主任。

张宏,男,教授,主任医师,中国医科大学附属盛京医院结肠直肠肿瘤外科副主任,医学博士,硕士研究生导师。1994年毕业于中国医科大学临床医学专业。曾留学日本金泽医科大学一般消化器外科。

刘金刚,教授,博士生导师。中国医科大学附属盛京医院外科教研室主任、普通外科主任。
Catalogue

第一篇 基础篇

腹腔镜手术中的筋膜及脉管系统解剖
总论
一专业术语的准确定义——剥离与切除、融合与粘连
1.剥离和切除的概念
2.融合和粘连的区别
3.腹腔镜下手术剥离的操作思路
二胎儿时期的腹膜构成、体壁
三肠管的旋转与腹膜
四胃与横结肠,尤其是横结肠中部的关系
五筋膜位置的组织胚胎学来源
六结直肠的血管解剖与淋巴结廓清度
1.右半结肠的血管解剖与淋巴结廓清度
2.左半结肠的血管解剖与淋巴结廓清度
3.结肠脾曲的血管解剖
七结肠癌手术术式的种类及定义
八脐的筋膜解剖和Hasson套管的插入方法
结语
第二篇 应用篇
腹腔镜下结直肠癌的手术基础
第一章腹腔镜下结直肠癌治疗的基本手术入路
1.手术体位
2.套管的留置部位
3.小肠移动与体位的变化
4.腹腔内的解剖学标志与腹腔探查
参考文献 23
第二章腹腔镜下乙状结肠切除术
一适应证
二切除范围,淋巴结廓清度
三病变位置的标记,术前准备
四乙状结肠手术的基本知识点
五乙状结肠的血管系统
六降结肠、乙状结肠和乙状结肠窝的筋膜组成
七手术操作
1.术中体位的选取
2.基本手术入路
3.手术流程
外侧入路
内侧入路
剥离直肠周围
从肛门侧切断乙状结肠或直肠
肠管吻合
插入引流管,闭合创口
八如何理解筋膜的构成
1.腹膜下筋膜深叶
2.直肠后方的筋膜构成——直肠固有筋膜
3.内侧入路的标志
4.外侧入路的标志
参考文献
第三章腹腔镜下直肠低位前切除术
一适应证
二切除范围,淋巴结廓清度
三病变位置的标记,术前准备
四乙状结肠、直肠的血管解剖
五直肠筋膜构成的基础
1.腹主动脉分叉部水平
2.骶骨岬水平
3.直肠膀胱窝水平
4.侧韧带水平
5.腹膜下筋膜深叶最下端尾侧水平
六手术操作
1.术中体位的选择
2.基本手术入路
3.手术流程
外侧入路
内侧入路
小骨盆腔内(特别是直肠后间隙)的游离
腹侧直肠的切断和游离(腹侧Denonvilliers筋膜的游离)
右侧直肠韧带的游离和切断
左侧直肠韧带的游离和切断
直肠腹侧面的游离和切开(Denonvilliers筋膜的切开)
直肠的切断
肠管的吻合
插入引流管和闭合切口
七腹腔镜手术中全新的临床解剖学的重要性——直肠筋膜的临床解剖
1.骨盆内筋膜的组成——直肠固有筋膜
2.内侧入路的标志
参考文献
第四章腹腔镜下腹会阴联合直肠切除术
一适应证
二切除范围,淋巴结廓清度
三造口部位标记,术前处置
四乙状结肠和直肠的血管解剖
五直肠筋膜组成的基础知识
六手术操作
1.术前处理
2.术中体位的选择
3.基本手术入路
4.手术流程
外侧入路
内侧入路
直肠背侧的游离
切断、游离直肠腹侧(游离Denonvilliers筋膜的腹侧)
切断、游离右侧韧带
切断、游离左侧韧带
尽可能切断、游离直肠腹侧(切断Denonvilliers筋膜)
切断乙状结肠
会阴部的操作
人工肛门的制作
戳卡位置的处理和人工肛门成形术
七盆底筋膜的构成和手术要点
参考文献
第五章腹腔镜下右半结肠切除术
一适应证
二切除范围,淋巴结廓清度
三病变位置的标记,术前处置
四肠系膜上动脉系的分支形态和淋巴结廓清
五右半结肠切除术的定义
六右侧结肠筋膜的构成
七手术操作
1.术中体位的选择
2.基本手术入路
3.手术流程
小肠系膜根部的切开、游离
自腹膜下筋膜深叶开始的游离
升结肠和横结肠的直线化
结肠肝曲的游离
小辅助切口开腹手术
肠管切除与吻合
闭合辅助切口
八右半结肠的筋膜结构
1.关于后腹膜入路的切开游离标志
2.关于内侧入路的游离操作
3.右半结肠的游离
参考文献
第六章腹腔镜下左半结肠切除术
一适应证


二切除范围,淋巴结廓清度
三病变位置的标记,术前处置
四结肠脾曲部特异的血管分布
五左侧结肠切除术的定义
六降结肠与结肠脾曲的筋膜构成
七手术流程
1.术中体位的选择
2.基本手术入路
3.手术流程
乙状结肠外侧入路
乙状结肠内侧入路
降结肠的游离
胃结肠系膜入路
腹部辅助小切口
肠管的切除、吻合
闭合创口
八结肠脾曲部的游离及对筋膜结构的理解
参考文献
第七章腹腔镜下结直肠次全切除术
一适应证
二切除范围,淋巴结廓清度
三病变位置的标记,术前处置
四大肠的血管解剖
五大肠筋膜的构成
1.右侧结肠
2.乙状结肠
3.直肠
4.结肠脾曲部
5.结肠肝曲部
六手术操作
1.术中体位的选择
2.基本手术入路
3.手术流程
右侧结肠的游离
通过内侧入路游离乙状结肠
直肠(特别是直肠后间隙)的游离
直肠腹侧的切开和游离(Denonvilliers筋膜腹侧的游离)
右侧韧带的切开和游离
左侧韧带的切开和游离 197
进一步切开和游离直肠腹侧(切开Denonvilliers筋膜)
直肠的切断
左侧结肠的游离
结肠肝曲的游离
上腹部的小切口开腹
肠管的吻合
插入引流管,闭合切口
七、一旦理解了筋膜的构成,未来将会在保证生存质量的前提下,进行腹腔镜下大肠全
切除术
参考文献

注意点
股疝的筋膜结构
十二指肠旁疝
乙状结肠的中间入路和外侧入路(MtL和LtM)
目前关于直肠筋膜组成的问题和观点——特别是手术技术及其整合性
骶骨旁筋膜的构成(Kraske手术)
关于右半结肠的内侧入路(Medial-to-lateral)vs外侧入路(Lateral-tomedial)
以筋膜解剖为基础的横结肠癌的手术操作——从横结肠肝曲、脾曲进入的外侧入
路的手术方式
腹部筋膜的构成中难以理解的地方的一点想法

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