引用文本：徐元亮, 熊文俊, 王伟, 等. 腹腔镜右半结肠切除术尾内侧入路联合中间翻页式清扫术技术要点[J/CD]. 消化肿瘤杂志（电子版）, 2025, 17(2):267-274.

作者：徐元亮¹，熊文俊²，王伟²，张子敬² ，李金² ，陈妍²

单位：1. 广州中医药大学第一临床学院，广东 广州 510405；2. 广州中医药大学第一附属医院 胃肠外科 广东省中医临床研究院，广东 广州 510405

Authors：Xu Yuanliang¹, Xiong Wenjun², Wang Wei², Zhang Zijing², Li Jin², Chen Yan²

Unit：1. The First Clinical College of Guangzhou University of Chinese Medicine, Guangdong Clinical Research Academy of Chinese Medical, Guangzhou 510405, Guangdong, China；2. Department of Gastrointestinal Surgery, the First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou 510405, Guangdong, China

摘要：

结直肠癌是我国常见恶性肿瘤，根治性手术切除是结肠癌的重要治疗手段。腹腔镜下根治性右半结肠切除术已在临床上广泛应用。目前有关腹腔镜下根治性右半结肠切除术的手术入路较多，如中间入路、尾侧入路、头侧入路等，笔者团队探索的尾内侧入路，以十二指肠为指引，由尾侧向头侧，自内侧向外侧分离右结肠后的Toldt间隙，重点解剖横结肠系膜、胃、胰十二指肠三者之间的融合间隙，从而降低肠系膜上血管部位淋巴结的清扫难度，符合无瘤原则，安全有效。该技术适用于位于盲肠、阑尾、升结肠、结肠肝曲及肝曲远端10 cm以内的肿瘤，以及临床诊断分期为Ⅰ~Ⅲ期或需局部根治的Ⅳ期肿瘤。术前需进行肠镜病理诊断、影像学检查评估术前分期和全身状况，做好肠道准备。手术采用平卧分腿位，常规五孔法，操作要点包括尾内侧入路、中间“三点一线”翻页式清扫、头外侧分离、体外吻合、冲洗检查等。此技术优势在于膜解剖清晰，手术标志明显，易于辨别层面，降低淋巴结清扫难度。

关键词：结肠肿瘤；腹腔镜；右半结肠切除术；手术入路

Abstract：

Colorectal cancer is a common malignant tumor in China, and surgical resection is an important radical treatment method for colon cancer. Laparoscopic radical right hemicolectomy has been widely used in clinical practice. There are numerous approaches for laparoscopic radical right hemicolectomy, such as the intermediate approach, the caudal approach, the cephalic approach, etc. The caudal-medial approach explored by the author’s team uses the duodenum as a guide. The dissection of the right retrocolic Toldt’s space is carried out from the caudal side to the cranial side and from the medial side to the lateral side. The focus is on the dissection of the fusion space among the transverse mesocolon, stomach, and pancreaticoduodenum，which reduces the difficulty of lymph node dissection at the superior mesenteric vessels site, conforms to the principle of tumor-free operation, and is safe and effective. This technique is applicable to patients with tumors located in the cecum, appendix, ascending colon, hepatic flexure of the colon, and within 10 cm distal to the hepatic flexure, and whose clinical diagnosis and staging are stage Ⅰ to Ⅲ or those with stage Ⅳ tumors requiring local radical treatment. Before the operation, colonoscopic pathological diagnosis, imaging examination for preoperative staging and general condition assessment, and bowel preparation are required. The operation is performed in the supine position with the legs separated, and the routine five-port method is used. The operation steps include the caudal medial approach, the flip-page type dissection in the middle with the "three points in a line", the cranial lateral dissection, extracorporeal anastomosis, flushing and inspection, etc. The advantage of this technique lies in the clear membrane anatomical planes, obvious surgical landmarks, easy identification of the layers, and reduction of the difficulty of lymph node dissection.

Key words：Colon neoplasms；Laparoscopy；Right hemicolectomySurgical approach

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