腹腔镜下完整系膜切除治疗右半结肠癌的相关解剖及临床疗效分析

The Clinical Curative Effect and Related Anatomy of Laparoscopic Complete Mesocolic Excision in Treatment of Right-side Colon Cancer

目的:探讨腹腔镜完整结肠系膜切除治疗右半结肠癌的相关解剖要点及临床疗效。方法:回顾性分析本院普通外科2011年1月-2014年1月腹腔镜下CME治疗右半结肠癌的30例患者,对其解剖要点及临床疗效进行分析。结果:30例患者中28例完成腹腔镜手术,中转率为6.7%,术后并发症发生率为7.1%,平均手术时间(142.4±34.4)min,平均术中出血量(80.5±25.2)mL,平均清扫淋巴结(15.8±6.6)枚,平均术后胃肠功能恢复时间(3.3±1.5)d,平均下床活动时间(2.1±1.2)d,平均住院时间(12.5±2.7)d;在血管解剖中,回结肠动脉位于回结肠静脉前方5例(17.9%)、前上方13例(46.4%)、前下3例(10.7%)、后方2例(7.1%)、后上3例(10.7%)、后下2例(7.1%)。右结肠动脉独立起自肠系膜上动脉者占43%(12/28),与中结肠动脉共干29%(8/28),与回结肠动脉共干者占18%(5/28),缺如者占10%(3/28)。胃结肠干出现率75.0%(21/28),其中包含右结肠静脉/上右结肠静脉的胃结肠干为89.3%(25/28)。结论:腹腔镜完整结肠系膜切除治疗右半结肠癌是安全可行的,正确的解剖间隙、解剖标志及血管定位是手术成功的关键。

Objective： To investigate the anatomical points and clinical curative effect of the laparoscopic complete mesocolic excision （ CME ）operation in treatment of right-side colon cancer.Method： The vascular anatomy and clinical curative effect of 30 patients with right-side colon cancer who received laparoscopic CME from January 2011 to January 2014 in our hospital were retrospective analyzed.Result： 28 cases underwent laparoscopic-assisted surgery successfully and 2 cases were converted to open surgery.The rate of laparotomy operation was 6.7%, the incidence of postoperative complications was 7.1%, the mean operation time, blood loss, number of dissected lymph nodes were （ 142.4 ± 34.4 ） minutes, （ 80.5 ± 25.2 ） mL and （ 15.8 ± 6.6 ） shell.The mean recovery time of gastrointestinal function, down from bed time, length of hospital stay were （ 3.3 ± 1.5 ） days, （ 2.1 ± 1.2 ） days, （ 12.5 ± 2.7 ） days.In vascular anatomy of the colon, ileocolic artery was located in the ahead of ileocolic vein had 5 cases （ 17.9% ）, upon the top had 13 cases （ 46.4% ）, under and forward had 3 cases （ 10.7% ）, back had 2 cases （ 7.1% ）, upon the top had 3 cases （ 10,7% ）, PI-Posterior Inferior had 2 cases （ 7.1% ） .Right colic artery independent from the superior mesenterie artery was 43% （ 12/28 ）, with the middle colic artery was 29% （ 8/28 ）, with the ileocolic artery was 18% （ 5/28 ）, absence was 10% （ 3/28 ） .Gastrocolic trunk was 75.0% （ 21/28 ）,contains the right colic vein/superior fight colic vein were 89.3% （ 25/28 ） . Conclusion： The laparoseopic complete mesocolic excision （ CME ） operation treatment right-side colon cancer is safe and feasible, grasp the anatomy and positioning of gastric blood vessel is the key to successful operation.