手术摘要：患者男性，72岁，因间断腹胀2个月入院。既往开腹阑尾切除手术史。辅助检查肠镜：距肛门70 cm环周肿物；活检：结肠腺癌。结肠增强CT：结肠肝曲处肠壁增厚，考虑结肠癌，符合T4aN1M0。诊断：结肠癌(cT4aN1M0)。手术：腹腔镜辅助根治性右半结肠切除术(D3)，右腹大网膜、腹壁、右半结肠粘连，首先采用外侧入路分离粘连及右半结肠系膜外侧达结肠肝曲；再采用内侧入路沿肠系膜上静脉由回结肠血管向头侧游离清扫，最后上腹辅助切口完成回结肠端侧吻合。

A male patient of 72 years old was admitted to hospital due to intermittent abdominal distension for 2 months. He had the previous history of open appendectomy for appendicitis. Endoscopic examination found colonic circumferential mass 70cm from the anal, with pathological result of colonic adenocarcinoma. Colonic mass was found at hepatic flexure of colon with T4aN1M0 staging by using colonic enhanced CT. Laparoscopic radical right hemicolectomy (D3) was performed as following: Adhesions between greater omentum, abdominal wall and right hemicolon were dissected firstly and the lateral right mesocolon was separated at the level of hepatic flexure of colon. Then, the medial approach was used to dissect the surgical trunk. Finally, End-to-side ileocolic anastomosis was completed with upper abdomen incision.