腹腔镜中间入路右半结肠癌根治术

Laparoscopic radical right hemicolectomy via medial approach for colon cancer

目的 探讨腹腔镜中间入路右半结肠癌根治术手术技巧及要点.方法 回顾性分析2012年11月至2014年6月兰州军区兰州总医院收治的84例结肠癌患者临床资料.肿瘤位于结肠肝区、升结肠、回盲部,患者均行腹腔镜中间入路右半结肠癌根治术.手术采用由内向外、自下而上的中间入路,以肠系膜上静脉外科干为中心清扫第3站淋巴结.观察患者术中情况,术后采用电话、短信和返院复查方式进行随访,随访时间截至2015年3月.结果 82例患者均行腹腔镜右半结肠癌根治术,2例患者中转开腹手术,无围术期死亡.患者平均手术时间为125 min（110～175 min）,术中平均出血量为50 mL（30～120 mL）,术中平均淋巴结清扫数目为17枚（13～20枚）.患者术后平均胃肠道恢复时间为52 h（24 ～72 h）,无输尿管、十二指肠损伤,无吻合口瘘、腹腔脓肿、切口感染等手术相关并发症发生,患者平均住院时间为6d（5～10 d）.72例患者术后获得随访,中位随访时间为21个月（12 ～ 28个月）,随访期间患者无切口及戳孔肿瘤转移.结论 腹腔镜中间入路右半结肠癌根治术以肠系膜上静脉外科干为中心的淋巴结清扫为手术操作要点,该手术方式安全可行,能有效改善患者预后.

Objective To explore the surgical techniques and key points of laparoscopic radical right hemicolectomy for colon cancer.Methods The clinical data of 84 patients with colon cancer who underwent laparoscopic radical right hemicolectomy at the General Hospital of Lanzhou Military Command from November 2012 to June 2014 were retrospectively analyzed.The tumors were located at the hepatic flexure of the colon,the ascending colon and the ileocecum.The inside-out and up-down medial approach was used as the main surgical approach,and D3 lymph node dissection based on a center of surgical trunk of the superior mesenteric vein was the key point of laparoscopic radical right hemicolectomy.The intraoperative and postoperative conditions of patients were observed.Patients were followed up by telephone interview,text message and examination of readmission till March 2015.Results Of 84 patients,82 received laparoscopic radical right hemicolectomy and 2 were converted to open operation without perioperative death.The mean operation time,volume of intraoperative blood loss,number of lymph node dissection,postoperative gastrointestinal recovery time and duration of hospital stay were 125 minutes （range,110-175 minutes）,50 mL （range,30-120 mL）,17 （range,13-20）,52 hours （range,24-72 hours） and 6 days （range,5-10 days）,respectively.There were no complications such as ureter injury,duodenal injury,anastomotic fistula,abdominal abscess and surgery-related complications.Seventy-two patients were followed up for a median time of 21 months （range,12-28 months） without the tumor metastasis of abdominal incision and sites of puncture.Conclusion Laparoscopic radical right hemicolectomy via the medial approach is safe and feasible as well as improving the prognosis of patients,and lymph node dissection based on a center of surgical trunk of the superior mesenteric vein is the key point of surgery.