手助腹腔镜扩大右半结肠切除血管骨骼化淋巴清扫术

Feasibility of lymphadenectomy with skeletonization in extended right hemicolectomy by hand-assisted laparoscopic surgery

目的探讨手助腹腔镜(HALS)能否模拟完成扩大右半结肠切除术中血管骨骼化淋巴结清扫。方法2001年11月至2004年9月由同一组医生对30例右半结肠癌患者分别完成HALS(腹腔镜组)和开腹手术(开腹组),各15例。分析比较两组患者的临床资料。结果腹腔镜组与开腹组的手术时间分别为(214.0±16.5)min和(245.0±24.6)min(t=2.248,P<0.05);术中出血量分别为(78.4±24.3)ml与(203.3±48.5)ml(t=4.927,P<0.05);术后肛门排气时间分别为(53.4±6.7)h与(67.3±9.7)h(t=2.530,P<0.05);术后住院天数分别为(11.5±1.11)d与(17.9±4.0)d(t=3.413,P<0.05);肠旁各站淋巴结数N1分别为(15.3±2.6)枚与(16.2±3.3)枚(t=0.48,P>0.05);N2分别为(5.6±1.6)枚与(5.9±2.2)枚(t=0.213,P>0.05),N3分别为(4.3±2.2)枚与(6.1±1.5)枚(t=1.429,P>0.05),两组患者术后并发症发生率分别为20.0%(3/15)与33.3%(5/15),(χ2=0.0227,P>0.05)。结论HALS可以很好地完成扩大右半结肠切除、术中血管骨骼化淋巴清扫这一高难度手术。

Objective To investigate the feasibility of lymphadenectomy with skeletonization in extended right hemicolectomy by hand-assisted laparoscopic surgery （HALS）. Methods From November 2001 to September 2004, 30 cases with right hemicolonic cancer were divided into two groups, and received laparoscopic or open extended right hemicolectomy plus lymphadenectomy with skeletonization. Clinical data of two groups were compared. Results The mean operative time were （214.0 ± 16. 5 ） min and （245.0 ± 24.6） min （t=2.248, P 〈0.05）, the mean volumes ofintraoperative bleeding （78.4±24.3） mland （203.3 ± 48.5） ml （ t = 4. 927, P 〈 0.05）, the mean time of anal aerofluxus （53.4 ± 6. 7 ） h and （67.3 ± 9. 7）h （ t = 2. 530, P 〈 0.05）, the mean postoperative hospital stay （ 11.5 ± 1.11 ）d and （ 17.9 ± 3.98）d （ t = 3. 413, P 〈 0. 05） respectively in laparoscopic and open operation groups. The mean numbers of N1, N2 and N3 lymph nodes cleared in laparoscopic group were （ 15.3 ± 2.6）, （5.6 ± 1.6） and （4.3 ± 2.2） respectively, while （16. 2 ±3.3）, （5.9 ±2. 2） and （6. 1 ± 1.5） respectively in open operation group （all P 〉 0.05）. The complication rates were 20. 0% （3/15） and 33.3% （5/15） respectively in laparoscopic and open operation groups （X^2 = 0. 0227, P 〉 0. 05） . Conclusion Extended right hemicolectomy plus lvmnhadenectomv with skeletonization can be nerfectlv nerformed by HALS.