下腹部外横内纵小切口取标本的全腹腔镜下右半肠癌根治术(右半类NOSES术)

Total laparoscopic radical resection of the right colon cancer with a small transverse and longitudinal incisions

目的探讨下腹部外横内纵小切口取标本的全腹腔镜下右半肠癌根治术安全性及可行性。方法回顾性分析中国医学科学院肿瘤医院结直肠外科自2017年6月至2018年10月期间34例实施下腹部外横内纵小切口取标本的全腹腔镜下右半肠癌根治术的患者的临床病理资料。结果全组患者手术均顺利完成。手术时间114～295(中位数176)min;出血量10～100(中位数30)ml;肿瘤大小1.1～9.5(中位数4)cm;下腹部外横内纵小切口长度4～7(中位数5)cm。患者术后排气时间18～96(中位数38)h,术后镇痛时间26～46(中位数36)h,术后住院时间4～11(中位数6)d。术后腹腔感染2例,均未出现吻合口漏等其他并发症,术后1个月内,无二次住院患者及死亡病例,术后随访3～16个月,未见局部复发或远处转移。结论下腹部外横内纵小切口取标本的腹腔镜下右半肠癌根治术安全可行,值得在临床推广。

Objective To investigate the safety and feasibility of the total laparoscopic radical resection of the right colon cancer with a small transverse and longitudinal incisions. Methods From June 2017 to October 2018,34 patients underwent total laparoscopic radical resection of the right colon cancer with a small transverse and longitudinal incisions at Department of Colorectal Surgery, Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College. The data of those patients was collected and reviewed retrospectively. Results All the patients in the group completed the operation successfully. The operation time ranged from 114 to 295 min (median 176 min);Blood loss ranged from 10 to100 (median 30) ml;Tumor size ranged from 1.1 to 9.5 cm (median 4 cm);The length of the small transverse and longitudinal incisions outside the lower abdomen ranged from 4 to 7 cm (median 5 cm).The patient s postoperative exhaust time ranged from 18 to 96 (median 38) h, postoperative analgesia time ranged from 26 to 46 (median 36) h, and postoperative hospitalization time ranged from 4 to 11 (median 6) days. Abdominal infection occurred in 2 cases without anastomotic fistula and other complications. Within 1 month after surgery, there was no hospitalized patients and no death cases. Follow-up was conducted for 3-16 months after surgery, and no local recurrence or distant metastasis was found. Conclusions Total laparoscopic radical resection of right colon cancer with small transverse and longitudinal incisions is safe and feasible, and worthy of clinical promotion.