以肠系膜上动脉左侧为右半结肠癌D3根治术淋巴结清扫内侧界的可行性研究

The feasibility of left superior mesenteric artery as inner boundary of laparoscopic D3 lymphadenectomy for right colon cancer

目的:探讨腹腔镜下中间入路以肠系膜上动脉为导向行右半结肠癌D3根治术的临床疗效。方法:对比分析2017年1月至2018年12月施行以肠系膜上动脉为导向(观察组,n=30)与以肠系膜上静脉为导向(对照组,n=28)的腹腔镜辅助右半结肠癌D3根治术患者的临床资料。结果:两组临床资料、手术时间、术中出血量、淋巴结清扫数量、术后排气时间、术后住院时间、并发症发生率等差异无统计学意义(P>0.05),观察组送检肠系膜上动脉前方及左侧淋巴结(No.D3),检出淋巴结数量(2.33±2.25)枚,发现淋巴结转移1例(3.3%)。无中转开腹,围手术期无输尿管损伤、十二指肠损伤、肠系膜上血管出血、吻合口漏、围手术期死亡等严重并发症发生。术后平均随访(21.6±6.3)个月,58例患者均无瘤存活。结论:以肠系膜上动脉为导向的腹腔镜辅助右半结肠D3根治性切除术安全、可行。

Objective:To investigate the clinical effect of right-sided colon cancer treated with laparoscopic D3 lymphadenectomy by superior mesenteric artery-guided middle approach.Methods:Comparative analysis was made on the clinical data of laparoscopic D3 lymphadenectomy for right-sided colon cancer guided by superior mesenteric artery(observation group,n=30)and superior mesenteric vein(control group,n=28)from Jan.2017 to Dec.2018.Results:There was no significant difference between the two groups in baseline data,operation time,intraoperative blood loss,number of lymph nodes dissection,postoperative exhaust time,postoperative hospital stay or complication incidence(P>0.05).In the observation group,the anterior and left lymph nodes(No.D3)of the superior mesenteric artery were examined.There were(2.33±2.25)lymph nodes detected,and 1 lymph node metastasis was found(3.3%).No cases were transferred to laparotomy,and no cases had serious operative complications such as ureter injury,duodenal injury,bleeding of the superior mesenteric vessels,anastomotic leakage or perioperative death.All patients were followed up for(21.6±6.3)months.All survived without tumor in the follow-up period.Conclusions:The laparoscopic radical right hemicolectomy with D3 lymphadenectomy guided by superior mesenteric artery is safe and feasible.