探讨基于膜解剖理论，腹腔镜下左半结肠完整系膜切除治疗脾区结肠癌的安全性、可行性及临床疗效。

自2016年1月至2019年6月，我中心33例脾曲结肠癌患者接受了腹腔镜下左半结肠切除术，所有患者均于术前经结肠镜下行活检病理确诊，同时给予纳米碳和(或)钛夹标记，腹部增强CT/立位腹平片确认病变位于脾曲，术前TNM分期为Ⅰ期5例、Ⅱ期19例、Ⅲ期9例。根据膜解剖理论，术中采取头侧－中间－外侧入路相结合的方式进行，注意保持层面优先及结肠系膜的完整性，于根部结扎、切断左结肠动脉、结肠中动脉左支和肠系膜下静脉，清扫223和253淋巴结。计量资料包括患者一般资料、手术参数、术后康复数据以(±s)表示，术后并发症发生率以%表示，采用SPSS 20.0统计软件进行数据分析。

33例手术均在腹腔镜下完成，无中转开腹。手术时间为(160.0±25.4) min，术中出血量为(70.6±46.4) ml，清扫淋巴结数目为(19.3±3.2)枚，标本肠管长度(23.0±2.8) cm，术后排气时间(4.5±1.2) d，术后进食时间(5.5±1.3) d，术后住院时间为(7.8±1.1) d。术后TNM分期为Ⅰ期4例、Ⅱ期21例、Ⅲ期8例。33例患者均未发生脾脏损伤，其中3例有不同程度的脾下极缺血，术后2例患者出现炎症性肠梗阻，保守治疗后康复出院。无术后腹腔出血、无吻合口漏、狭窄、出血等并发症发生。随访8～49个月(中位随访时间26个月)，目前患者均健康存活，未见肿瘤复发、转移。

对于脾曲结肠癌，在遵循膜解剖理论、层面优先原则的前提下，采用头侧－中间－外侧入路进行腹腔镜下左半结肠切除术，可以将操作化繁为简，具有安全、微创、可靠等优点，值得在临床推广应用。

To investigate the safety and feasibility and clinical outcome of laparoscopic complete mesocolic excision (CME) for left colon cancer at splenic flexure based on membrane anatomy.

From Jan 2016 to Jun 2019, 33 patients with left colon cancer at splenic flexure were enrolled in the present study, who underwent laparoscopic CME, and their clinical data were analyzed retrospectively. All of 33 patients received preoperative colonoscope and the lesions were labeled by using nano carbon and/or titanium clip, eventually they were all diagnosed by biopsy and pathological examination. The lesions were confirmed to be located at splenic flexure by preoperative examinations of abdominal enhanced CT and/or standing abdominal X-ray. There were 5 cases of stage Ⅰ, 19 cases of stage Ⅱ and 9 cases of stage Ⅲ in preoperative TNM staging evaluation. Based on the theories of membrane anatomy and CME, the operations were carried out by using a combined cephalic-middle-lateral approach. The roots of left colon artery, left branch of middle colon artery and inferior mesenteric vein were ligated and cut off respectively, then the 223 and 253 lymph nodes were dissected. Measurement data such as general data of patients, operation parameters and postoperative rehabilitation data were expressed as (±s). The incidence of postoperative complications were expressed as %. Statistical analysis were performed by using SPSS 20.0 software.

All of 33 patients receive successful laparoscopic left colectomy without conversion, with the operation time of (160.0±25.4)min and intraoperative blood loss of (70.6±46.4)ml. The number of harvested lymph nodes were (19.3±3.2) and the length of specimens were (23.0±2.8) cm. Rapid recovery of patients were observed with the first exhaust time of(4.5±1.2) d, the oral feeding time of (5.5±1.3) d and postoperative hospital stay of(7.8±1.1) d. There were 4 cases of stage Ⅰ, 21 cases of stage Ⅱ and 8 cases of stage Ⅲ in postoperative TNM staging evaluation. There were 2 cases of inflammatory ileus after operation, who recovered after conservative treatment. No postoperative abdominal bleeding and anastomotic complications occurred. All the patients survived without tumor recurrence and metastasis during the followed-up of 8~49 months (median follow-up time of 26 months).

Based on the theories of membrane anatomy, for colon cancer at splenic flexure, the cephalic-middle-lateral approach makes it possible to clearly visualize the pancreas and origin of the transverse mesocolon, leading to safe splenic flexure mobilization and complete mesocolic excision. It appears to be safe and feasible and could be a promising method for selected patients with left colon cancer.