尾内侧入路联合中间翻页式淋巴结清扫腹腔镜右半结肠癌根治术疗效观察

Efficacy observation of the caudal-medial approach combined with"page-turning"middle lymphadenectomy in the laparoscopic right hemicolectomy

目的探讨尾内侧入路联合中间翻页式淋巴结清扫腹腔镜右半结肠癌根治术的安全性和可行性。方法采用描述性病例系列研究的方法,回顾性分析2018年4月至2020年5月,在广东省中医院胃肠外科,由同一主刀医师连续完成尾内侧入路联合中间翻页式清扫腹腔镜右半结肠根治术35例患者的临床资料。结果35例患者均顺利完成手术,术中无肠系膜上血管及动脉分支、静脉属支损伤出血。手术时间为(186.9±46.2)min,术中出血量为50(10~200)ml,术后首次排气时间(2.1±0.6)d、流质饮食时间(2.5±0.8)d,术后住院时间6(3~18)d。术后总体并发症发生率8.6%(3/35),根据Clavien-Dindo分级标准,Ⅱ级1例(2.8%)、Ⅲa级2例(5.7%)。淋巴结清扫总数为(30.2±5.6)枚,阳性淋巴结为0(0~7)枚。肿瘤分期:Ⅰ期5例,Ⅱ期18例,Ⅲ期11例,ⅣA期1例。中位随访时间15(4~29)个月,1例患者术后12个月因脑血管意外死亡,余患者未见肿瘤复发转移。结论尾内侧入路联合中间翻页式淋巴结清扫腹腔镜右半结肠癌根治术,优先拓展胰头十二指肠前间隙,降低中线侧清扫难度,安全可行。

Objective To investigate the safety and feasibility of caudal-medial approach combined with"page-turning"middle lymphadenectomy in the laparoscopic right hemicolectomy.Methods A descriptive cohort study was conducted.Clinical data of 35 patients who underwent laparoscopic radical right hemicolectomy using caudal-medial approach combined with"page-turning"middle lymphadenectomy at Department of Gastrointestinal Surgery,Guangdong Hospital of Chinese Medicine from April 2018 to May 2020 were retrospectively analyzed.All operations were performed consecutively by the same surgeon.The caudal-medial approach was used to dissect the right Toldt's fascia and the anterior pancreaticoduodenal space in a caudal-to-cranial and medial-to-lateral manner guided by the duodenum.The"page-turning"middle lymphadenectomy was used to dissect the mesocolon along the superior mesenteric vein with ileocolic vein,Henle's trunk and pancreas exposed preferentially.Results All the 35 patients completed the operation successfully,and there was no damage and bleeding of superior mesenteric vessels and their branches.The operative time was(186.9±46.2)minutes,and the blood loss was 50(10-200)ml.The first time to flatus was(2.1±0.6)days,and the time to fluid intake was(2.5±0.8)days.The postoperative hospital stay was 6(3-18)d.The overall morbidity of postoperative complication was 8.6%(3/35),including grade II in 1 cases(2.8%)and grade IIIa in 2 case(5.7%)according to the Clavien-Dindo grading standard.The total number of lymph node dissected was 30.2±5.6,and the positive lymph node was 0(0-7).Tumor staging revealed 5 cases of stage I,18 cases of stage II,11 cases of stage III,and 1 case of stage IVA.In this study,the median follow-up time was 15(4-29)months.One patient died due to cerebrovascular accident 12 months after surgery,and no tumor recurrence or metastasis was observed in all other patients.Conclusions Laparoscopic radical right hemicolectomy using caudal-medial approach combined with"page-turning"middle lymphadenectomy is safe and feasible.The anterior pancreaticoduodenal space is preferentially mobilized,which reduces the difficulty of central vascular dissection.