腹腔镜右半结肠癌根治术177例临床分析

The clinical analysis of laparoscopic-assisted radical right hemicolectomy:a report of 177 cases

目的:探讨腹腔镜下右半结肠癌根治术的安全性及远期疗效。方法:回顾分析2002年2月至2009年3月间177例行腹腔镜下右半结肠癌D3根治术病人的临床资料,研究其手术安全性及近远期疗效。结果:本研究病人的平均手术时间(132.6±35.7)min,术中出血(94.2±34.1)mL,术后肠道排气时间、恢复流质饮食时间、术后住院天数分别为(2.13±0.74)d、(3.21±0.45)d、(10.35±2.72)d;平均切除标本长度(17.32±8.26)cm,淋巴结清扫数目(15±8)枚。中转开腹5例(2.82%),腹腔镜手助切除4例(2.26%)。并发症24例(13.56%)。术后随访39(12～97)个月,随访期内发现1例戳创孔肿瘤种植,局部复发5例(2.82%),远处转移7例(其中肺转移2例,肝转移4例,骨转移1例)。累计生存率、无病生存率及肿瘤相关生存率分别为83.69%、80.43%及83.14%。Dukes A期、B期、C期的5年生存率分别为93.23%、76.47%、66.67%。结论:腹腔镜右半结肠癌根治术是安全且符合肿瘤根治原则的,并能获得令人满意的近、远期疗效。

Objective To explore the feasibility and safety and the long term outcome of laparoscopic assisted right hemicolectomy for colonic carcinoma.Methods The safety of operation,status of recovery,complication,oncological clearance and results of short and long term follow-up were studied in 177 patients underwent laparoscopic-assisted right hemicolectomy for colonic cancer between Feb.2002 and Mar.2009.Results No case die in this study,five cases（2.82 %） were converted to open surgery.Four cases（2.26 %） underwent laparoscopic right hemicolectomy with hand-assisted.The average operation time was（132.6±35.7） min and the blood loss was（94.2±34.1） m1.The average time for passage of flatus,food eating and hospitalization were（2.13±0.74） d,（3.21±0.45） d,（10.35±2.72） d respectively.The total number of lymph nodes removed was（15±8）.Complications were observed in 24 of 177 patients（13.56 %）.The median follow-up period was 39（12-97） months,1 port-site recurrence（PSR） was observed in one patient,local recurrence was found in 5 cases（2.82 %）,7 cases were found distant metastasis,there were 2 pulmonary metastasis,4 hepatic metastasis and 1 bony metastasis.The cumulative survival,disease-free survival and tumor-specific overall survival were 83.69 %,80.43 % and 83.14 %.The five years’ survival rate of 3 stage（Dukes A,B,C） were 93.23 %,76.47 % and 66.67 % respectively.Conclusions Laparoscopic-assisted right hemicolectomy can be successfully performed for right colon carcinoma with all the advantages of minimally invasive surgery.Moreover the short and long term outcome is indicated effective and ideal.