腹腔镜辅助右半结肠切除术35例临床分析

Clinical analysis of laparoscopy-assisted right hemi colectomy:a report of 35 cases

目的探讨腹腔镜外科技术在右半结肠切除手术中的应用。方法对1999年8月至2003年8月施行腹腔镜辅助右半结肠切除术的35例患者的临床资料和随访情况进行回顾性分析。结果33例在腹腔镜下完成右半结肠分离,辅助小切口,于腹腔外行肠系膜上动静脉周围淋巴清扫、右半结肠切除和吻合。无手术死亡,中转开腹2例,中转率5.7%(2/35)。平均手术时间181min,平均出血量94ml,辅助切口平均长5cm,平均术后住院日9d,术后早期肠梗阻1例。33例患者术后随访1～48个月,1例DukesC2期中分化腺癌患者,术后4个月发现双肺及左锁骨上淋巴结转移。全组患者的Trocar穿刺孔及腹壁切口无肿瘤种植转移。结论腹腔镜辅助右半结肠切除术是安全可行的,适合于各期的回盲部和升结肠肿瘤。只要手术医师遵守肿瘤处理原则、熟练掌握腹腔镜技术,就能顺利地完成此类手术。

Objective To evaluate the feasibility of laparoscopy assisted right hemi colectomy. Methods Thirty five cases who underwent laparoscopic assisted right hemi colectomy from August 1999 to August 2003 were registered and followed up. Results Right hemi colon was dissected and separated from the abdominal wall by laparoscopic instruments in 33 cases, then, resection of right hemi colon and anastomosis were performed with a small assistant incision outside the abdominal cavity. No operative death occurred. Two patients required open operation finally and the conversion rate was 5.7%(2/35). The mean operative time was 181 min, the mean blood loss was 94 ml, the mean length of assistant incision was 5 cm, and the mean postoperative hospital stay was 9 days. Intestinal obstruction occurred only in one case early after operation. The follow up period was from 1 to 48 months. Metastasis in double lungs and left supraclavicular lymph nodes was found in one patient 4 months after operation, who was in Dukes C2 stage with moderate differentiated adenocarcinama. No Trocar site and incision recurrence was found. Conclusions Laparoscopy assisted right hemi colectomy is both feasible and safe, and applicable to hemi right colonic tumors of varied kinds and different stages. All these operations should be performed by skilled surgeons with oncology principle.