右半结肠癌D3根治术32例临床研究

Right hemicolectomy with D3 lymph node dissection for 32 cases of right colon cancer

目的探讨右半结肠D3根治术的临床应用。方法2000年5月￣2006年5月,对32例右半结肠癌患者行D3根治术。手术完整切除Toldt筋膜及胰头十二指肠前筋膜,游离肠系膜上静脉外科干,根部结扎肠系膜血管,清扫N3淋巴结。肝曲癌再切除右肾前筋膜,清扫幽门下淋巴结。肿瘤侵出Toldt筋膜清扫其下腹膜下筋膜(Gerota筋膜),作右半结肠切除。结果手术清扫淋巴结每例达15￣76枚,平均28枚。术后并发症21.88%(7/32),其中切口感染3例,术后炎症性肠梗阻2例,急性左心衰及肺部感染各1例。无围手术期死亡患者。32例患者随访8￣72个月,平均38个月,生存36个月以上22例,6例分别于术后8、14、18、24、25和32个月死亡。随访期间失访4例。结论右半结肠D3根治术是减少肿瘤复发的有效术式,仔细操作并不增加手术并发症。

[Objective] To investigate the efficacy of right hemicoloectomy with D3 lymph node dissection for right colon cancer. [Methods] A total of 32 cases was given right hemicoloectomy with D3 lymph node dissection from May 2000 to May 2006. After the Toldt＇s fascial and the anteior fascial of pacreaticodudenum were totally excised, the superior mesenteric vein surgical trunks were dissociated and the high ligation of the mesenteric vessels should be performed, then the lymph nodes along the surgical trunk at the root of the superior mesenteric vessels were initially dissected. The right prerenal fascial and the subpyloric nodes should be excised when the tumor lain in hepatic flexure of colon. The Grota＇s fascical should be＇dissected when the tumor invading the Toldt＇s fascical. And the right transverse colon and the ascending colon were isolated. Then a transection of the bowel and an end-to-end is were conducted extracorpereally. [Results ] The total number of lymph nodes harvested was 15- 76 （mean, 28） . The postoperative morbidity rate was 21.8% （7/32） , including incision infection in 3 cases, ileus in 2 cases, Acute left heart failure and pulmonary infections in 2 cases. A total of 32 cases were followed for 8-72 months （mean, 38 months）. There was no dead patient during the perioperative period. The survival time was over 36 months in 22 cases, 6 cases were died respectively in 8, 14,18,24,25,32 months after surgery. Meanwhile a loss to follow-up was recorded in 4 cases. [ Condusion] Right hemicoloectomy with D3 lymph node dissection is an effective way to reduce neoplasm recurrence without more operative complications.