腹腔镜下右半结肠癌D3根治术

Laparoscopic right hemicolectomy with D3 lymph node dissection for right colon cancer

目的：探讨遵循非接触分离原则右半结肠癌腹腔镜下D3根治术的方法。方法：1996年6月～2004年8月对87例右半结肠癌腹腔镜下行D3根治术，按照沿外科干游离肠系膜上血管根部淋巴结、游离右半横结肠与升结肠、体外肿瘤肠管切除并吻合的手术路径进行手术。结果：手术时间120～397min，平均212min。淋巴结清扫总数9～91枚，平均35枚；其中结肠上旁淋巴结0～50枚，平均17．5枚；系膜间淋巴结0～20枚，平均10．4枚；血管根部淋巴结0～39枚，平均7．5枚。术后并发症发生率16．1％（14／87），其中切口感染8例（9．2％），术后肠梗阻2例（2．3％），术后吻合口周围炎2例（2．3％），腹腔脓肿与局限性积液2例（2．3％）。84例随访12～113个月，平均45个月，生存3年以上30例，期间失访36例。结论：在遵循肿瘤完整切除原则下，选择合适的手术入路，术中操作路线明确、出血少、视野清晰，是完成腹腔镜下右半结肠痛切除术的关键。

Objective To explore the efficacy of laparoscopic right hemicoloectomy with D3 lymph node dissection for right colon cancer based on a no-touch isolation technique. Methods A total of 87 cases was given laparoseopie right hemieoloeetomy with D3 lymph node dissection from June 1996 to August 2004. The lymph nodes along the surgical trunk at the root of the superior mesenterie vessels were initially dissected. And the right transverse colon and the ascending colon were isolated. Then a transection of the bowel and an end-to-end enteroanastomosis were conducted extracorporeally. Results The operative time was 120 ～397 min （mean, 212 vain）. The total number of lymph nodes harvested was 9 ～ 91 （mean, 35 ） , including 0～50 （mean, 17.5） paraeolie and epieolie lymph nodes, 0～ 20 （mean, 10.4） intermesenterie nodes, and 0 ～39 （ mean, 7.5） artery root nodes. The postoperative morbidity rate was 16. 1% （14/87） , including incision infection in 8 cases （9.2%）, ileus in 2 cases （2.3%）, perianastomotie inflammation in 2 cases （2.3%）, and intraabdominal abscess and fluid collection in 2 cases （2.3%）. A total of 84 cases were followed for 12 ～ 113 months （mean, 45 months）. The survival time was over 3 years in 30 eases. Meanwhile a loss to follow-up was recorded in 36 cases. Conclusions Based on the principle of en bloc resection of tumor, a proper approach with clear access, low bleeding, and good visualization is the key to perform laparoseopie right hemieoloeetomy.