摘要
3D腹腔镜在临床的应用是工业与医学结合的产物,改变了外科医生对原有解剖结构的认识,使得曾今无法辨识的亚微结构真实而又立体地呈现在眼前。3D腹腔镜所具有的三维立体空间感,可以帮助外科医生在手术当中很容易地找寻到正确的解剖层面和筋膜间隙。3D腹腔镜右半结肠癌全直肠系膜切除术(CME)过程中,利用3D腹腔镜视野的纵深感和对亚微结构的真实呈现,沿着右侧Toldt筋膜与泌尿生殖筋膜之间的筋膜间隙拓展升结肠后间隙及横结肠后间隙,辨识胰十二指肠前筋膜、Treitz筋膜及Fredet筋膜,确保右半结肠脏层系膜和背侧的泌尿生殖筋膜的完整性,最终实现整块移除右半结肠及其系膜,完成右半结肠全系膜切除术。此外,3D腹腔镜呈现出立体的三维空间,可以清晰地显露外科干,并对血管根部淋巴结进行立体清扫,以实现D3根治术。完美的CME+D3根治术可以改善进展期右半结肠癌患者5年生存率并降低局部复发率。手术视野的良好显露和对筋膜层面的正确辨识,是实现右半结肠癌CME+D3根治术的关键,而3D腹腔镜在右半结肠癌CME+D3根治术中恰恰扮演了“导演”的角色,指引“一号主角”即主刀医生进入到神圣外科层面(surgical plane),保证了右半结肠癌CME+D3手术的安全性和手术质量。
The clinical application of 3D laparoscopy is the product of the combination of industry and medicine,which has changed the surgeon’s understanding of the original anatomical structure,and made the sub-microstructure that once could not be recognized present in reality and three-dimensional.The sense of three-dimensional space of 3D laparoscopy can help surgeons to find the correct anatomical layers and fascial space easily.3D laparoscopic right hemicolectomy for colorectal cancer,In the process of CME,the longitudinal depth of 3D laparoscopic field of vision and the true presentation of sub-microstructure were used to expand the posterior space of ascending colon and the posterior space of transverse colon along the fascial space between the right Toldt fascia and urogenital fascia,so as to identify the anterior pancreaticoduodenal fascia,Treitz fascia and Fredet fascia,and to ensure the integrity of the visceral mesocolon and the dorsal urogenital fascia,and also to realize the right colon and its mesentery are removed in en bloc finally.In addition,3D laparoscopy presents a three-dimensional space,which can clearly reveal the surgical trunk,and perform three-dimensional dissection of the lymph nodes at the root of the blood vessels to achieve D3 lymphadenectomy.The optimal CME+D3 radical operation can improve 5-year survival rate and reduce local recurrence rate of patients with advanced right colon cancer.Good exposure of operative field and correct identification of fascial layer are the key to achieve CME+D3 radical resection of right colon cancer,while 3D laparoscopy plays the role of"director"in CME+D3 radical resection of right colon cancer,and guides the chief surgeon as No.1 player into the holy plane,which ensures the safety and quality of CME+D3 operation.
作者
燕速
马新福
赵康
陈筱乾
郭灿
Yan Su;Ma Xinfu;Zhao Kang;Chen Xiaoqian;Guo Can(Department of Gastrointestinal Surgery,Qinghai University Affiliated Hospital,Xining,810001,China)
出处
《中华普外科手术学杂志（电子版）》
2020年第5期441-448,共8页
Chinese Journal of Operative Procedures of General Surgery(Electronic Edition)
基金
青海省消化系统疾病临床医学研究中心科技成果转化专项(2019-SF-L3)
青海省肿瘤临床医学研究中心科技成果转化专项(2018-SF-113)。
