以回结肠血管为标记的右下入路法腹腔镜辅助根治性右半结肠切除术

Radical Laparoscopic-assisted Right Hemicolectomy via the Lower Right Approach with the Ileocolonic Blood Vessels as a Surgical Mark

目的探讨以回结肠血管为标记右下入路法腹腔镜辅助根治性右半结肠切除术的临床效果。方法 2010年1月～2011年12月,对28例结肠癌行腹腔镜辅助根治性右半结肠切除术,术中采用以回结肠血管为标记右下入路法,即先以回结肠血管为标记,建立融合筋膜间隙(Toldt’s间隙)外科平面,再以肠系膜上静脉为标记,建立胰腺十二指肠前筋膜间隙外科平面的手术入路与手术路径进行手术。结果 28例均顺利完成腹腔镜辅助根治性右半结肠切除术,无中转开腹,术中未发生肠系膜上静脉、十二指肠、输尿管、生殖血管损伤等手术并发症。术中出血量(89±17)ml,手术时间(158±21)min,清扫淋巴结(19.6±1.8)枚,术后排气时间(64.4±10.2)h,术后住院时间(8.9±1.7)d。术后无切口感染、吻合口漏、腹腔脓肿等并发症。28例随访6～30个月,平均17.2月,均未发现吻合口复发、穿刺孔或小辅助切口种植转移、远处转移等。结论以回结肠血管为标记右下入路法能快速准确地进入Toldt’s间隙和胰腺十二指肠前筋膜间隙,减少肠系膜上静脉损伤机会,既能保证肿瘤的根治性,又能保证手术的安全性。

Objective To investigate the efficacy of radical laparoscopic-assisted right hemieolectomy via lower right approach with the ileocolonic blood vessels as a surgical mark. Methods From January 2010 to December 2011, 28 patients with colonal cancer underwent radical laparoscopic-assisted right hemicolectomy in our hospital. Via the lower right approach, with the ileocolonic blood vessels being marked, we established surgical field with the fusion fascial spaces （Toldt＇ s gap） , and then with the marked superior mesenteric vein, a surgical field of the pancreatic duodenal anterior fascia gap was established. Results The procedure was completed in all the 28 patients without conversion to open surgery. No injury to the superior mesenteric vein, duodenum, ureter or genital vessels, or other complications occurred. The mean operation time, intraoperative blood loss, number of removed lymph nodes, postoperative recovery time of gastrointestinal function, and postoperative hospital stay were （158 ± 21 ） min, （89 ±17 ） ml, 19.6 ：l： 1.8, （64.4 ± 10.2） h, and （8.9 ± 1.7） d. No patients developed incisional infection, anastomotic leakage, intra-abdominal abscess occurred. The patients were followed up for 6 to 30 months with a mean of 17. 2 months, during which no recurrence, tumor implantation or metastasis was detected. Conclusion It is quicker and more accurate to enter into the Toldt＇ s gap and pancreatic duodenal anterior fascia gap via a lower right approach with the ileocolonic blood vessels as a surgical mark. The procedure is safe and guarantees the cure of the tumor.