多入路行腹腔镜肠系膜上血管根部清扫的临床运用

The clinic application of the procedure to clear the root of the superior mesenteric vessels with multi-approach

目的：探讨在腹腔镜辅助右半结肠全系膜切除术中多入路清扫肠系膜上血管根部的临床价值。方法回顾性析2011年1月～2013年12月间在腹腔镜辅助右半结肠全系膜切除术的28例患者资料，其中接受多入路清扫肠系膜上血管根部的12例，设为观察组；单纯逆肠系膜上静脉清扫的16例，设为对照组。比较两组间出血量、手术时间及清扫淋巴结数量等指标。结果所有患者顺利完成手术，无中转开腹。两组间多项指标比较，观察组平均大致出血量少于对照组，平均清扫淋巴结个数多于对照组；而平均手术时间、平均术后排气时间及术后下床时间两组间差异无统计学意义。结论采用多入路法行腹腔镜下肠系膜上血管根部清扫可降低配合要求，减少出血，清扫更彻底，更加符合无瘤手术原则。

Objective To investigate the clinic merit of the procedure to clear the root of the superior mesenteric vessels with multi-approach. Methods The materials of 28 patients who underwent the laparoscopic right hemicolectomy which embraced the clearing the root of superior mesenteric vessel by CME rule from January 2011 to December 2013 were retrospectively analyzed.All patients were divided into two groups.12 patients were in observation group who underwent the clear the root of SMV by the multi-approach. 16 patients were allocated to the control group who underwent the same operation by the classic approach.The information between both groups were compared,such as blood loss,operation time,harvested lymph and other indexes. Results All operations were performed successfully. NO one was converted to open operation.The mean blood loss in observation group was less than that in the control group;the average number of lymphs harvested in observation group was more than that in the control group.There were no differences of the mean operation time,postoperative anus exhaust time and under the bed time between the two groups. Conclusion The procedure to clear the root of superior mesenteric vessels with multi-approach in laparoscopic right hemicolectomy decreased the cooperative difficulty,made the blood loss less.This procedure was more in line with the no-tumor principle.