两孔法腹腔镜辅助右半结肠癌完整系膜切除术技术要点及短期疗效

Short-term efficacy and technical strategy of single-incision plus one assist port laparoscopic complete mesorectal excision(CME)of right colon cancer

目的探讨两孔法腹腔镜辅助完整结肠系膜切除术治疗右半结肠癌的手术要点及短期疗效。方法回顾分析广东省人民医院胃肠外科2019年3月至2019年12月两孔法腹腔镜辅助完整结肠系膜切除术治疗右半结肠癌17例患者的临床资料,评估手术指标和疗效。结果本组患者手术切口长度(5.6±3.1)cm、手术时间(126.0±27.8)min、术中出血量(21.2±14.9)mL、清扫淋巴结(33.8±11.2)枚,阳性淋巴结75%分位数为1枚(0~9枚)。术后首次排气时间(1.5±0.6)d,首次进流质饮食时间(1.3±0.6)d,首次进半流质饮食时间为(4.1±2.3)d,术后并发症5例(淋巴漏3例、腹腔出血1例、肺部感染1例),术后平均住院时间(7.9±4.5)d。结论两孔法腹腔镜辅助完整结肠系膜切除术治疗右半结肠癌安全可行,术中淋巴结清扫时应注意避免损伤胃-结肠静脉干。

Objective To investigate the feasibility and safety of single-incision plus one assist port laparoscopic complete mesorectal excision(CME)in the treatment of right colon cancer.Methods The clinical data of 17 patients with right-sided colon cancer who underwent single-incision plus one assist port laparoscopic complete mesorectal excision in the department of Gastrointestinal Surgery of Guangdong Provincial People’s Hospital from March 2019 to December 2019 were retrospectively analyzed.The surgical indicators and efficacy were evaluated.Results In this group of 17 patients,the incision length was(5.6±3.1)cm,the operation time was(126.0±27.8)min,the intraoperative blood loss was(21.2±14.9)mL,the number of detected lymph nodes was(33.8±11.2),and the 75th percentile of positive lymph nodes was 1(range:0-9).The time of first exhaustion after surgery was(1.5±0.6)d.The first time for consumption of liquid was(1.3±0.6)d,and the time of first meal semifluid was(4.1±2.3)d.There were five postoperative complications including lymphatic fistula in 3 cases,abdominal bleeding in 1 case,and pulmonary infection in 1 case,the average postoperative hospitalization was(7.9±4.5)d.Conclusions Single-incision plus one assist port laparoscopic complete mesorectal excision for the treatment of right colon cancer is safe and feasible.During the lymph nodes dissection operation,attention should be paid to avoid injury on the gastrocolonic vein.