腹腔镜扩大结肠癌根治术与单纯中横结肠癌根治术解剖学及临床意义

Anatomy and clinical significance of laparoscopic extended radical resection and simple radical resection of transverse colon cancer

目的探索中横结肠癌解剖学及生物学特性的关联,研究术式选择的差异与预后关系,确定最佳手术方式。方法利用解剖学和影像学数据,研究大体标本、三维血管重建图,回顾性分析中横结肠癌患者不同腹腔镜手术方式的临床效果和生存情况。结果(1)解剖并观察大体标本,发现一、二级血管结扎可确保结肠吻合口的血液供应;(2)术前三维血管重建与术中血管探查符合率大于90%;(3)横结肠切除组与扩大结肠切除组相比,术中出血量、手术时间、术后并发症、总生存率无统计学差异,两组淋巴结清扫数目有统计学差异。结论腹腔镜下单纯横结肠切除较扩大结肠癌根治术有降低术后并发症风险趋势,两者预后无统计学差异,横结肠切除是中横结肠癌最佳手术方式。

Objective To explore the relationship between anatomy and biological characteristics of middle transverse colon cancer,to study the relationship between the choice of operation and prognosis,and to determine the best mode of operation.Methods Using anatomical and imaging data,gross specimens and three-dimensional vascular reconstruction maps were studied,and the clinical effects and survival of patients with middle transverse colon cancer treated by different laparoscopic operations were analyzed retrospectively.Results(1)The primary and secondary vascular ligation can ensure the blood supply of the anastomotic colon;(2)The coincidence rate of preoperative three-dimensional vascular reconstruction and intraoperative vascular exploration was more than 90%;(3)There was no statistical difference in the intraoperative bleeding volume,operation time,postoperative complications and overall survival rate between the transverse colectomy group and the expanded colectomy group.There was significant difference in the number of lymph node dissection between the two groups.Conclusions Laparoscopic transverse colectomy alone has a tendency to reduce the risk of postoperative complications compared with extended radical resection of colon cancer,and there is no statistical difference in prognosis between them.Transverse colectomy is the best surgical method for middle transverse colon cancer.