腹腔镜右半结肠切除术35例临床分析

The clinical analysis of laparoscopic-assisted right hemicolectomy:a report of 35 cases

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：回顾分析2002年2月至2004年12月行腹腔镜辅助右半结肠切除术35例患者的临床资料和随访情况，以研究其手术的安全性，术后康复情况及肿瘤的根治性效果。结果：术中未发生严重并发症和死亡病例，2例（5．7％）中转开腹，手术时间（155．14±35．79）min，术中出血（111．43±87．62）ml，辅助切口长（5．69±1．00）cm，患者排气时间（2．54±1．12）d，总住院时间（14．54±6、45）d。清扫淋巴结总数14（0～50）枚，其中结肠上、旁淋巴结4（0～21）枚，系膜间淋巴结5（0—18）枚，血管根部淋巴结3（0—35）枚，手术切除标本长度（20．73±7.14）cm，肺部感染、术后腹水、腹腔局部积液、乳糜漏各1例，余者未见术后并发症，患者均获随访，平均41个月（8—68个月），2例局部复发，3例术后发生肝转移，累计生存率为76．8％。结论：腹腔镜右半结肠切除术治疗右半结肠癌安全有效，符合肿瘤根治原则。

Objective：To explore the feasibility and safety of laparoscopic-assisted right hemicolectomy for colonic carcinoma, Methods ：The safety of operation, status of recovery, complication, oneological clearance and results of short term follow-up were studied in 35 patients underwent laparoscopic-assisted right hemicolectomy for colonic cancer between Feb. 2002 and Dec. 2004. Results ： Two cases （5.7%） were converted to open surgery. The average operative time was （ 155.14 ± 35.79） min and the blood loss was （ 111.43 ± 87.62 ） ml. The average incision length was （5.69 ± 1.00） cm. The average time for passage of flatus and hospitalization were （2.54 ± 1.12 ） d, （ 14.54± 6.45 ） d respectively. The total number of lymph nodes removed was 14 （0-50）, and the average length of specimen removed was（20.73 ± 7.14 ）cm. Complilations were observed in 4 of 35 patients, that were pulmonary infection, abdominal part fluidify,abdominal dropsy and chylus leak. The average follow-up time was 41 months（8-68months）. The cumulative survival rate at 41 months was 76.8%. Conclusions：Laparoscopie-assisted right hemieolectomy can be successfully performed for right colon carcinoma with all the advantages of minimally invasive surgery.