腹腔镜辅助右半结肠切除治疗结肠癌48例分析

Laparoscopic-assisted Right Hemicolectomy in the Treatment of Colonic Carcinoma （Analysis of 48 Cases）

探讨腹腔镜辅助右半结肠切除治疗结肠癌的可行性和安全性。回顾分析腹腔镜辅助右半结肠切除治疗结肠癌48例。全组无手术死亡，中转开腹手术3例，手术时间（232．3±52．8）min，出血量（152．9±66．0）ml，切除淋巴结（15．1±5．8）枚。肛门排气时间为（2．3±0．6）d，可起床活动时间为（2．1±0．7）d，住院时间（10．5±2．7）d。并发症5例，分别为脾损伤、肠系膜上静脉损伤、切口感染、肠梗阻及肺感染。随访时间3个月至4年，1例术后1年出现局部复发，1例术后1年出现腹腔及左锁骨上淋巴结转移，1例术后2年出现右肺转移。结果表明，腹腔镜右半结肠切除治疗结肠癌具有疼痛轻、恢复快等优点，技术上安全可行，最终结果仍有待于大量长期的前瞻性随机对照研究证实。

The objective of the study was to assess the feasibility and safety of laparoscopic-assisted right hemicolectomy of colonic carcinoma. Fourty eight cases with colonic carcinoma underwent such surgical treatment,the data of which were analized retrospectively. Data showed that there was no case dead of operation, 3 cases were converted to laparotomy, the mean operative duration of time was （232.3 ±52.8） minutes, the hemorrhage volume was （152.9 ± 66.0）ml, the removed lymph nodes were 15.1±5.8, the gaspassing time was postoperatively （2.3±0.6）days, bed-side walking time was postoperatively （2. 1±0.7 ） days ,and the hospitalization time was （10.5±2.7） days. It was also revealed that complications occurred in 6 cases（splenic trauma, trauma of superior mesenteric vein, wound infection, intestinal obstruction and in- fection of the lung）, follow up of 3 monthes to 4 years found local recurrence in one case 1 year after operation,metastasis to abdominal cavity and left supraclavicular lymph nodes in one case 1 years after operation,and pulmonary metastasis in one case 2 years after operation. It is suggested that laparoscopic-assisted right hemicolectomy in the treatment of colonic carcinoma has definite advantages such as less pain and quicker recovery,and is proved to be a safe ＆ reliable procedure,while further prospective and long-term controlled studies are expected.