腹腔镜辅助右半结肠切除术根治结肠癌

Laparoscopic-assisted right hemicolectomy for colon carcinoma

目的:探讨腹腔镜右半结肠切除术治疗结肠癌的安全性与有效性。方法:对2000年9月至2003年10月我科为41例右半结肠癌病人所行的腹腔镜右半结肠切除术进行随访,以研究其手术安全性、术后恢复情况及肿瘤的根治性效果。结果:无术中严重并发症和手术死亡病例,2例(4.9%)中转开腹手术;手术时间为(152.65±28.29)min、术中出血平均(112.94±96.36)ml。病人排气时间、下床时间、住院天数分别为(2.24±0.56)、(3.94±1.64)、(13.94±6.5)d。清扫淋巴结总数(11.24±8.02)枚[结肠上旁淋巴结(6.82±4.72)枚,系膜间淋巴结(2.59±2.43)枚,血管根部淋巴结(1.82±2.53)枚],手术切除标本长度(20.88±5.28)cm;除2例肺部感染、1例术后肠梗阻外余病人未见术后并发症;所有病人均获随访(12～46)个月,平均(29.15±7.95)个月,2例(4.9%)局部复发,3例(7.3%)发生肝转移,短期(46个月)累计生存率为74.50%。结论:腹腔镜右半结肠切除术治疗右半结肠癌是安全有效的,符合肿瘤根治原则。

Objective To assess the feasibility and safety of laparoscopic-assisted right hemicolectomy for colon carcinoma. Methods The safety of operation, status of recovery, complications, oncological clearance and results of short-term follow-up were studied in 41 patients underwent laparoscopic-assisted right hemicolectomy for colon cancer between September 2000 and October 2003. Results Two cases (4.9%) were converted to open surgery. The mean operative time was (152.65±28.29) min and the blood loss was (112.94±96.36) ml. The mean time for passage of flatus, time to resume early activity and that of hospital stay were (2.24±0.56), (3.94±1.64) and (13.94±6.5) days respectively. The total number of lymph nodes removed was 11.24±8.02, and the overage length of specimen removed was 20.88±5.28 cm. Complications were observed in 3 of 41 patients, with 2 cases of pulmonary infection and 1 case of ileus. The mean follow-up time was (29.15±7.95) (12-46) m. The cumulative survival rate at 46 months was 74.50%. Conclusion Laparoscopic-assisted right hemicolectomy can be successfully performed for colon cancer, with all the advantages of minimally invasive surgery.