引用文本：胡靖渝, 黄仁力, 朱江赢, 等. 全腹腔镜下联合入路右半结肠癌根治术的技术要点[J/CD]. 消化肿瘤杂志（电子版）, 2026, 18(3): 488-495.

作者：胡靖渝，黄仁力，朱江赢，曹粤，何沅陈，阮浩峰，邹兆伟

单位：南方医科大学珠江医院 胃肠外科，广东 广州 510282

Authors：Hu Jingyu, Huang Renli, Zhu Jiangying, Cao Yue, He Yuanchen, Ruan Haofeng, Zou Zhaowei

Unit：Department of Gastrointestinal Surgery, Zhujiang Hospital, Southern Medical University, Guangzhou 510282, Guangdong, China

摘要：

结直肠癌是我国常见恶性肿瘤，腹腔镜右半结肠切除术是其主要根治手段。目前腹腔镜右半结肠癌根治术的手术入路多样，包括中间、尾侧及头侧入路等。笔者团队提出头‑尾‑中间联合入路技术，通过头侧优先处理Henle干、尾侧建立Toldt间隙、中间根部处理血管的序贯操作，实现解剖层次清晰、血管暴露充分、淋巴结清扫彻底。该术式适用于Ⅰ~Ⅲ期右半结肠癌，术前需完善肠镜病理诊断、增强计算机断层扫描检查及评估全身状况、做好肠道准备。手术采用平卧分腿位与5孔法布局，操作涵盖头侧Henle干解剖、横结肠与回肠离断、尾侧间隙分离、中间血管根部清扫及体内吻合等步骤。该联合入路融合各入路优势，手术流程顺畅、层面清晰，有利于减少术中出血、缩短手术时间，适合临床推广与学习。

关键词：结肠肿瘤；腹腔镜；右半结肠切除术；联合入路；手术入路

Abstract：

 Colorectal cancer is a common malignant tumor in China, and laparoscopic right hemicolectomy serves as a primary radical treatment. Currently, various surgical approaches for laparoscopic radical resection of right colon cancer exist, including the medial, caudal, and cephalad approaches. The author's team proposes a combined cephalad‑caudal‑medial approach. This technique involves sequential steps: prioritizing the identification and management of Henle's trunk via the cephalad approach, establishing the Toldt's space via the caudal approach, and performing central vascular ligation with D3 lymphadenectomy via the medial approach. This strategy ensures clear anatomical planes, adequate vascular exposure, and thorough lymph node dissection. The procedure is indicated for stage Ⅰ‑Ⅲ right‑sided colon cancers. Preoperative workup includes pathological confirmation via colonoscopy, enhanced computed tomography for staging, systemic assessment, and bowel preparation. The patient is placed in a supine split‑leg position, and a standard five‑port configuration is used. Key procedural steps encompass dissection of Henle's trunk, transection of the transverse colon and ileum, separation of the caudal Toldt's space, root‑level vascular dissection, and intracorporeal anastomosis. By integrating the advantages of different approaches, this combined method provides a logical, standardized, and visually clear operative workflow, which contributes to reduced intraoperative bleeding, shorter operative time, and a smoother learning curve, making it suitable for clinical adoption and training.

Key words：Colonic neoplasms; Laparoscopy; Right hemicolectomy; Combined approach; Surgical approach

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