腹腔镜尾侧入路右半结肠癌根治性切除的安全性、可行性及临床应用价值

The safety, feasibility and clinical application of laparoscopic radical right hemicolectomy using a caudal-to-cranial approach

目的探讨尾侧入路法腹腔镜右半结肠癌根治性切除术的安全性、可行性及临床应用价值。方法回顾性分析2014年1月至2015年12月广东省中医院胃肠外科右半结肠癌病例90例,接受尾侧入路法腹腔镜右半结肠癌根治性切除术。结果 90例患者均完成手术,无死亡。手术总体并发症11.1%,其中1例(1.1%)患者因术中助手暴力撕裂回结肠静脉汇入SMV处出血,经开腹小切口修补血管后继续在腹腔镜下成功完成手术。术后并发症发生率为10%,其中包括3例(3.3%)肺部感染、2例(2.2%)泌尿系感染、1例(1.1%)切口感染、2例(2.2%)炎性肠梗阻和1例(1.1%)淋巴瘘,均经保守治疗后痊愈出院。手术时间为146.8±30.5 min,术中失血量为68.4±37.9 ml,首次排气时间为49.7±21.5 h,恢复流质饮食时间为58.1±13.2 h,术后住院时间为7.8±3.2 d,平均淋巴结清扫数目为29.8±9.9枚,其中淋巴结阳性数目为4.1±2.1枚。结论尾侧入路法腹腔镜右半结肠癌根治性切除术是安全、可行的,符合肿瘤学根治原则,在缩短外科医生腹腔镜右半结肠切除术的学习曲线和保障手术安全方面会提供有益的帮助。

Objective To investigate the safety, feasibility and efficacy of laparoscopic radicalright hemicolectomy using a caudal-to-cranial approach. Methods From January 2014 to December 2015,90 cases with curable right-side colon cancer underwent laparoscopic radical right hemicolectomy using acaudal-to-cranial approach. The general clinical characteristics, intraoperative and postoperative outcomeswere analyzed retrospectively. Results All 90 cases underwent laparoscopic surgery successfully. Theoverall complication rate was 11.1%. One patient (1.1%) had intraoperative ileocolic artery bleeding dueto violent retraction and was then successfully managed through a small incision. The total postoperativecomplication rate was 11.1%, three cases (3.3%) with pulmonary infection, two (2.2%) urinary systeminfection, one (1.1%) wound infection, two (2.2%) inflammatory bowel obstruction and one (1.1%) lymphfistula, all treated conservatively with no reoperation. The mean blood loss was 68.4±37.9 ml, meanoperative time 146.8±30.5 min , time of first flatus 49.7±21.5 hours , liquid diet 58.1±13.2 hours. Thepostoperative hospital stay was 7.8±3.2 day. The mean number of lymph nodes harvested was 29.8±9.9,and the mean positive lymph nodes was 4.1±2.1. Conclusions The caudal-to-cranial approach is safe andfeasible for laparoscopic radical right hemicolectomy; it meets the principle of surgical oncology and may behelpful to shorten the learning curve of laparoscopic right hemicolectomy.