右半结肠癌根治术合并十二指肠缺损修复治疗的体会

Repair treatment of duodenal defect in radical resection of colon cancer in right hemicolon

目的探讨右半结肠癌根治术合并十二指肠缺损修复治疗的疗效及并发症。方法 2008年2月至2011年2月,对12例右半结肠癌侵及十二指肠患者行D3根治术,十二指肠缺损的修复均用3-0爱惜康可吸收线横向连续全层缝合,1号丝线间断浆肌层缝合加强,留置复尔凯鼻肠管至空肠,十二指肠创面旁置冲洗引流管一根。观察手术情况、并发症及预后。结果 12例均一期恢复,无围手术期死亡,术后无十二指肠瘘、狭窄、梗阻及溃疡等并发症,术后1个月上消化道钡餐造影显示十二指肠蠕动和排空正常。术后所有患者均接受术后辅助化疗8～12周期,截止2011年7月,除2例发生肝转移再次手术切除病灶外,其余患者均无复发及转移征象。结论右半结肠癌侵犯十二指肠行D3根治术是减少肿瘤复发的有效术式,对十二指肠缺损采用横向连续全层缝合加间断浆肌层加强以及留置鼻肠管,利于创面愈合,加速患者康复。

Objective To explore the radical surgical treatment of right colon carcinoma and repair treatment of hepatic flexure invading the duodenum.Methods Twelve patients with right colon carcinoma of hepatic flexure invading the duodenum treated in our department from February 2008 to February 2011,were enrolled in this study.Ethicon braided absorbable 3-0 line suture was applied to repair duodenal defect by transversal full-thickness suture,and the flocare naso-intestinal feeding tube was put into jejunum to enforce enteral nutrition.Results All the 12 cases recovered smoothly.No patient died after operation and no complication occurred such as fistula,anastomotic stenosis and ulcer.Upper gastrointestinal barium showed duodenal motility and emptying were normal after 1 month of operation.All patients received postoperative adjuvant chemotherapy for 8-12 cycles.Up to July 2011,10 patients still alived without signs of recurrence and metastasis.Conclusion To reduce local recurrence of right colon carcinoma of hepatic flexure invading the duodenum,D3 lymph node dissection is an effective technique.Transversal full-thickness suture with 3-0 adsorbable ethicon suture to repair duodenal coloboma can simplify operation,reduce injury and save time.Early enteral nutrition after surgery is beneficial for duodenal wound and the patients can recover quickly.