3D腹腔镜右半结肠癌根治术经阴道取标本的应用体会

Application of transvaginal 3D laparoscopic radical operation of right colon cancer

目的探讨3D腹腔镜右半结肠癌根治术经阴道取标本的安全性和可行性。方法回顾性分析2015年10月至2018年2月间在河南大学淮河医院接受经阴道取标本的3D腹腔镜右半结肠癌根治术的13例女性患者的临床资料。中间入路,按全结肠系膜切除原则处理血管、清扫淋巴结,游离右半结肠、结肠肝曲和部分回肠系膜后,在横结肠和回肠末端预切断吻合处打开肠腔,腔内直线切割闭合器行回肠-横结肠侧侧吻合,更换枪钉后闭合切断回肠和横结肠完成标本切除和吻合。切开阴道后穹窿,经阴道置入保护套,将标本通过保护套经阴道后穹窿切口拖出体外,腔镜下缝合阴道后穹窿切口。所有患者于术前和术后3个月分别填写盆底功能障碍问卷(PFDI-20),对盆底功能障碍中盆腔、直肠和膀胱功能进行评价。结果 13例女性患者中,年龄58~76(中位62)岁,体质指数20.8~34.5(中位31)Kg/m2,肿瘤位于结肠肝曲4例,回盲部7例,升结肠2例,全组患者手术均顺利完成,无一例中转开腹。手术时间164~232(中位176)min,术中出血50~200(中位100)ml,清扫淋巴结13~18(中位14)枚,术后排气时间1.8~5.2(中位2.8)d,术后住院时间6.3~9.2(中位6.8)d,术后无吻合口出血、吻合口漏或腹腔内感染病例。随访4~30个月未见局部复发和远处转移病例。术前与术后3个月患者的盆底功能评分差异均无统计学意义(P>0.05)。结论经阴道取标本的3D腹腔镜右半结肠癌根治术具有一定优势且不影响患者的盆底功能,是安全可行的。

ObjectiveTo investigate the clinical value of 3D high-resolution laparoscope in transvaginal radical operation of right colon cancer. MethodsA retrospective study was performed on thirteen patients. Who were operated by transvaginal 3D laparoscopic radical operation of right colon cancer in Huaihe Hospital of Henan University from October 2015 to February 2018. We take the middle approach, according to the principle of total colonic mesangial excision, treatment of blood vessels, dissection of lymph nodes, free right colon, colonic hepatic ？exure and partial ileum mesentery, open the intestinal cavity at the end of the transverse colon and ileum, side to side anastomosis of ileal transverse colon by Endo-GIA. After the replacement of the nail, the incision and anastomosis of the ileum and transverse colon were completed. Incision of the posterior fornix of the vagina, the specimen was dragged out through the vaginal fornix incision through the protective sleeve.Suture the posterior fornix of the vagina by endoscopic suture. ResultsAmong the thirteen female patients, the age was 58~76 （median 62）, and the body mass index 20.8~34.5 （median 31） Kg/m2. Four cases of tumor were located in the colonic hepatic ？exure, seven cases of ileocecal and 2 cases of ascending colon. All operation were successfully completed, and no case wasconverted to laparotomy. The operation time was 164~232 （median 176） min, intraoperative hemorrhage 50~200 （median 100） ml, 13~18 （median 14） of lymph node, 1.8~5.2 （median 2.8） days after operation, 6.3~9.2 （median 6.8） days after operation. There was no case of anastomotic bleeding, anastomotic leakage or intraperitoneal infection after operation. No local recurrence or distant metastasis was observed after 4~30 months follow-up. ConclusionTransvaginal 3D laparoscopic right hemicolon radical resection has certain advantages and does not affect the pelvic ？oor function. It is safe and feasible.