全结肠系膜切除在腹腔镜辅助右半结肠癌根治性切除中的应用与评价

Laparoscopic complete mesocolic excision in radical right hemi-colon resection

目的探讨全结肠系膜切除术(complete mesocolic excision,CME)和血管高位结扎在腹腔镜辅助右半结肠癌根治术中的应用,并评估其效果和安全性。方法分析2010年6月至2012年2月腹腔镜右半结肠癌CME手术23例,采用历史对照的方法与传统开腹右半结肠癌根治手术32例患者对比,评估两组患者的临床病理学特点以及围手术期情况。结果 23例右半结肠癌腹腔镜辅助下CME根治手术均顺利完成,无中转开腹。右半结肠癌腹腔镜辅助CME根治术患者每例患者平均清扫淋巴结(18.1±5.3)枚,传统开腹对照组平均清扫淋巴结(15.1±3.8)枚,腹腔镜CME组清扫淋巴结数目明显多于传统开腹组(P=0.013)。腹腔镜CME手术组与传统开腹手术组的手术时间分别为(207.39±41.15)min和(225.16±76.62)min(P>0.05)。腹腔镜CME组术中出血量平均(124.0±32.8)ml,开腹组则高达(170±39.6)ml,差异有统计学意义(P<0.05)。腹腔镜CME组术后并发症发生率仅为13.0%,与传统手术相似,无吻合口瘘和输尿管损伤等严重并发症发生。结论右半结肠癌腹腔镜辅助下CME及血管高位结扎安全可行,并发症发生率并无升高,但尚需大规模前瞻性随机对照研究探讨其远期疗效。

Objective To evaluate the role of laparoscopic complete mesocolic excision (CME) and central vessel ligation in radical right hemi-colon resection. Methods From June 2010 to February 2012, laparoscopic CME were performed in 23 patients with right hemi-colon cancer. Clinicopathological and perioperative data were compared between the 23 patients with laparoscopic CME and 32 cases with traditional open radical right hemi-colon resection as historical control. Results Laparoscopic CME was performed successfully in all 23 patients without conversion to open operation. The average number of lymph nodes harvested was (18.1±5.3) in the laparoscopic CME group and (15.1±3.8)in the traditional open group (P=0.013). The mean operative time was (207.39 ±41.15)min and (225.16 ±76.62)min (P>0.05), the mean intraoperative blood loss was (124.0±32.8)ml and (170±39.6)ml (P<0.05), respectively in the CME and traditional groups. The postoperative complication rate in the CME group was 13.0% in comparison with 18.8% in the traditional open group (P>0.05). There was no severe complications such as anastomotic leakage and ureteral injury in the CME group. Conclusions CME technique in laparoscopic radical right hemi-colon resection is feasible and safe with more lymph nodes harvested and no severe complications. Further prospective randomised clinical trials should be carried out to evaluate the long-term outcomes of laparoscopic CME.