单切口腹腔镜辅助右半结肠切除术手术入路的探讨

Research about operative approach for single incision laparoscopic-assisted right hemicolectomy

目的：探讨侧方入路单切口腹腔镜辅助右半结肠切除术的可行性及手术优点。方法：回顾分析为11例患者采用侧方入路行单切口腹腔镜右半结肠切除术的临床资料。结果：本组11例患者系膜均完整切除，1例因肿瘤过大且与后腹膜粘连紧密中转开腹，余均顺利完成手术。手术时间平均（225±30）min，术中出血量平均（50±15）ml，术中无输尿管、胰腺或十二指肠损伤等，术后无大出血、腹腔内疝及吻合漏等并发症发生。平均住院（10．5±1．25）d。术后随访3～24个月，中位随访8个月，无慢性腹痛或吻合口狭窄征象。结论：单切口腹腔镜右半结肠切除术的入路选择非常重要，是手术成功实施的关键因素。经侧方入路行单切口腹腔镜右半结肠切除术具有解剖层次清楚、手术时间短、术中出血少等优点，手术安全、可行。

Objective：To investigate the advantage and feasibility of the lateral approach single incision laparoscopic-assisted right hemicolectomy. Methods：The lateral approach single incision laparoscopic-assisted right hemieolectomy was performed on 11 pa- tients with right colon cancer＇. The clinical data was reviewed retrospectively. Results：In this group of 11 patients, mesentery was com- pletely resected. All the operations were successful except for one patient who was converted to laparotomy because of a huge tumor which stuck together with the posterior peritoneum. Average operation time and bleeding during the surgery was （ 225 ± 30 ） mix and （50 ± 15 ） ml, respectively. The ureter, pancreas and duodenum were not damaged. Complications such as postoperative hemorrhea, in- tra-abdominal hernia and anastomotic leakage did not occurred. Average hospital stay was （ 10.5 ±1.25 ） d, post-operative follow-up was 3 to 24 months and median follow-up was 8 months. There was no chronic abdominalgia or anastomotie stenosis. Conclusions ：The choice of operation approach is extremely important and the key factor in the single incision laparoscopic-assisted right hemieoleetomy. The lateral approach has the advantages such as clear anatomical level, safe and feasible operation, short operative time and little blood loss.