腹腔镜辅助下结肠脾曲癌根治术

Laparoscopic assisted radical resection of splenic flexure carcinoma

目的总结腹腔镜辅助下结肠脾曲游离的方法及根治要点。方法应用腹腔镜技术,对21例结肠脾曲或近脾曲结肠癌病人实施手术治疗。以腹主动脉表面为中间入路的切入点,游离Toldt间隙,于胃网膜血管弓下离断胃结肠韧带,于胰腺下缘离断横结肠系膜根部,结扎相应血管,清扫No253和No223淋巴结。并通过左上腹部小切口在腹腔外进行切除,并行肠管端端吻合术。结果20例成功完成腹腔镜下操作,1例因肿瘤侵及胃大弯侧,腹腔镜下完成大部分操作,切除部分胃壁时中转开腹。腹腔镜平均时间(65.4±6.1)分钟;淋巴结清扫数目平均(20.6±3.1)枚;术中平均出血量(30.7±6.2)ml;辅助切口平均长度(8.5±1.5)cm;术后住院(6.8±0.9)天。无其他切口或穿刺口并发症发生,无肠漏及腹腔感染等发生。结论腹腔镜下结肠脾曲游离的规范化、No253和No223淋巴结清扫目的及技巧的掌握,使腹腔镜下结肠脾曲癌的治疗成为一种安全有效的方式。

Objective To summarize the methods and key points of laparoscopic assisted colon splenic flexure free.Methods 21 cases of colon cancer with splenic flexure or proximal splenic flexure were treated by laparoscopy.The gastrocolic ligament was cut off under the gastroepiploic vascular arch,and the root of transverse mesocolon was cut off at the lower edge of pancreas.The corresponding vessels were ligated and the lymph nodes of No253 and No223 were removed.Through the small incision in the left upper abdomen,the resection was performed outside the abdominal cavity,and the end-to-end anastomosis was performed.Results 20 patient were successfully performed under laparoscopy.One patient was converted to laparotomy when part of the gastric wall was resected because the tumor invaded the greater curvature of the stomach.The average time of laparoscopy was(65.4±6.1)min.The average number of lymph nodes was(20.6±3.1).The average blood loss was(30.7±6.2)ml.The average length of auxiliary incision was(8.5±1.5)cm.,and the postoperative hospital stay was(6.8±0.9)d.No other incision or puncture site complications,intestinal fistula and abdominal infection occurred.Conclusion Standardized laparoscopic is a safe and effective treatment for the colon splenic flexure dissociation The prospective study of D3 dissection can achieve safe results.