回结肠血管为入路标志的腹腔镜辅助下右半结肠根治术24例报告

Laparoscopic-assisted Resection of the Right Colon under Ileocolic Artery Approach Signs:A Report of 24 Cases

目的探讨回结肠血管为入路标志的腹腔镜辅助右半结肠根治术的难点及处理。方法 2009年1月～2012年1月对24例结肠癌行腹腔镜辅助右半结肠根治术。按肿瘤处理原则,内侧入路,结扎相应血管,清扫淋巴结,并通过小切口在腹腔外进行切除吻合。结果 24例均成功完成手术,无中转开腹。手术时间136～200 min,平均150 min。术中出血15～200 ml,平均40 ml。清扫淋巴结12～25枚,平均17枚。辅助切口4～7 cm,平均5 cm。术后住院6～9 d,平均7 d。除1例术后切口液化感染外,无其他切口或穿刺口并发症发生,无肠漏及腹腔感染等发生。18例随访6～24个月,平均12个月,2例发生肝转移,其余患者未见有肿瘤复发或转移。结论正确选择后腹膜切开点,有利于肠系膜上静脉游离和融合筋膜间隙的分离;正确理解全结肠系膜切除、熟知胃结肠干的解剖变异,是减少术中出血和顺利完成规范化手术的成功要点。

Objective To explore the difficulties and management of laparoscopic-assisted resection of the right colon for right colon cancer. Methods Laparoscopic-assisted resection of the right colon was performed on 24 patients with right colon cancer between January 2009 and January 2012. By medial parapatellar approach, mesenteric vessels were ligated and lymphectomy was completed under laparoscopy. The resection of the right colon and end-to-end anastomosis of the residual bowels were performed through a small incision outside abdominal cavity. Results The operation was completed in all the cases without conversion to open surgery. The operation time was 136-200 min with a mean of 150 min. The total number of lymph nodes removed was 12-25 with a mean of 17. The mean intraoperative blood loss was 40 ml（range： 15-200 ml）. The average hospital stay was 6-9 d with a mean of 7 d. Accessorial incision was 4 - 7 cm with an average of 5 cm in length. Incision liquefaction infection occurred in one patient and no complication was found at the incision or abdominal cavity in other cases. Eighteen patients were followed up for 6 - 24 months with a mean of 12 months. Liver metastasis occurred in 2 patients. No recurrence or metastasis was found in the other patients. Conclusions The choice of the proper posterior peritoneum incision is vital for seperating Told＇ s fascia and the superior mesenteric vein（SMV）. A proper understanding of complete mesocolic excision and familiarity with the anatomy variation of gastrocolic trunk are keies to perform laparoscopic hemicolectomy successfully.