AIM:To illustrate the critical techniques and feasibility of laparoscopic extended right hemicolectomy(LERH),according to our previous experience.METHODS:Anatomical relationship and operative techniques were demonstra...AIM:To illustrate the critical techniques and feasibility of laparoscopic extended right hemicolectomy(LERH),according to our previous experience.METHODS:Anatomical relationship and operative techniques were demonstrated.One hundred and five consecutive patients who underwent extended right hemicolectomy with D3 lymphadenectomy between January 2008 and May 2011 were included in the present study[laparoscopic group(n=48)vs open group(n=57)].RESULTS:The right retrocolic space was the main surgical plan of the LERH.The superior mesenteric vein was the most important anatomical landmark for vascular dissection.The medial-to-lateral dissection approach made the LERH performed efficiently.Compared with the open group,the LERH group had less blood loss(111.7±127.8 mL vs 170.2±49.7 mL,P=0.023),faster return of flatus(3.0±1.6 d vs 3.7±1.3 d,P=0.019),and earlier diet(4.2±1.4 d vs 5.0±1.2 d,P=0.005).Five patients(10.4%)underwent conversion during laparoscopic surgery.The cancer recurrence rates between the two groups were comparable(laparoscopic vs open,8.6%vs 9.1%,P=0.335).CONCLUSION:For an advanced tumor located at the hepatic flexure or proximal transverse colon,LERH with D3 lymphadenectomy using a medial-to-lateral approach seems to be safe and feasible when the superior mesenteric vein serves as the main anatomical landmark and the right retrocolic space severed as the surgical plan.展开更多
目的探讨“肠系膜下动脉优先解剖联合完全内侧入路”(priority anatomy of the inferior mesenteric artery combined with complete medial approach,IMA—CMA)结肠脾曲游离技术在腹腔镜左半结肠癌根治术中的应用效果。方法收集2016年...目的探讨“肠系膜下动脉优先解剖联合完全内侧入路”(priority anatomy of the inferior mesenteric artery combined with complete medial approach,IMA—CMA)结肠脾曲游离技术在腹腔镜左半结肠癌根治术中的应用效果。方法收集2016年7月至2021年12月由本团队实施腹腔镜左半结肠癌根治术的74例患者的临床资料进行回顾性分析,按照手术方式的不同,将患者分为传统入路(traditional approach,TA)组与IMA—CMA组,每组纳入患者例数分别为43例、31例。将两组患者的临床基线资料按照1∶1的比例进行倾向性评分匹配(propensity score matching,PSM),最终每组各纳入22例患者进行分析。记录两组术中情况(手术时间,术中出血量,脾出血事件,淋巴结清扫总数,253组淋巴结清扫数目)和术后恢复情况(术后住院时间,Clavien-DindoⅡ级及以上的术后并发症发生情况)。结果与TA组相比,IMA—CMA组的平均手术时间更短,中位术中出血量更少,253组淋巴结清扫数目更多,差异均有统计学意义(均P<0.05)。两组脾出血事件发生率、淋巴结清扫总数及术后住院时间比较差异均无统计学意义(均P>0.05)。TA组共发生Clavien-DindoⅡ级及以上的术后并发症2例,均为肠梗阻;IMA—CMA组共发生Clavien-DindoⅡ级及以上的术后并发症3例,包括肠梗阻1例、腹腔感染1例、肺栓塞1例。两组Clavien-DindoⅡ级及以上的术后并发症发生率及术后肠梗阻、腹腔感染、肺栓塞的发生率比较差异均无统计学意义(均P>0.05)。两组均无术后腹腔出血病例。结论“肠系膜下动脉优先解剖联合完全内侧入路”结肠脾曲游离技术安全可行,有助于缩短手术时间和减少术中出血量,有利于253组淋巴结充分清扫,且不增加围手术期并发症的发生率。展开更多
基金Supported by National High Technology Research and Development Program of China,No.2012AA021103the Program of Guangdong Provincial Department of Science and Technology,No.2012A030400012+1 种基金the Major Program of Science and Technology Program of Guangzhou,No.201300000087the subproject under National Science and Technology Support Program,No.2013BAI05B00
文摘AIM:To illustrate the critical techniques and feasibility of laparoscopic extended right hemicolectomy(LERH),according to our previous experience.METHODS:Anatomical relationship and operative techniques were demonstrated.One hundred and five consecutive patients who underwent extended right hemicolectomy with D3 lymphadenectomy between January 2008 and May 2011 were included in the present study[laparoscopic group(n=48)vs open group(n=57)].RESULTS:The right retrocolic space was the main surgical plan of the LERH.The superior mesenteric vein was the most important anatomical landmark for vascular dissection.The medial-to-lateral dissection approach made the LERH performed efficiently.Compared with the open group,the LERH group had less blood loss(111.7±127.8 mL vs 170.2±49.7 mL,P=0.023),faster return of flatus(3.0±1.6 d vs 3.7±1.3 d,P=0.019),and earlier diet(4.2±1.4 d vs 5.0±1.2 d,P=0.005).Five patients(10.4%)underwent conversion during laparoscopic surgery.The cancer recurrence rates between the two groups were comparable(laparoscopic vs open,8.6%vs 9.1%,P=0.335).CONCLUSION:For an advanced tumor located at the hepatic flexure or proximal transverse colon,LERH with D3 lymphadenectomy using a medial-to-lateral approach seems to be safe and feasible when the superior mesenteric vein serves as the main anatomical landmark and the right retrocolic space severed as the surgical plan.
文摘目的探讨“肠系膜下动脉优先解剖联合完全内侧入路”(priority anatomy of the inferior mesenteric artery combined with complete medial approach,IMA—CMA)结肠脾曲游离技术在腹腔镜左半结肠癌根治术中的应用效果。方法收集2016年7月至2021年12月由本团队实施腹腔镜左半结肠癌根治术的74例患者的临床资料进行回顾性分析,按照手术方式的不同,将患者分为传统入路(traditional approach,TA)组与IMA—CMA组,每组纳入患者例数分别为43例、31例。将两组患者的临床基线资料按照1∶1的比例进行倾向性评分匹配(propensity score matching,PSM),最终每组各纳入22例患者进行分析。记录两组术中情况(手术时间,术中出血量,脾出血事件,淋巴结清扫总数,253组淋巴结清扫数目)和术后恢复情况(术后住院时间,Clavien-DindoⅡ级及以上的术后并发症发生情况)。结果与TA组相比,IMA—CMA组的平均手术时间更短,中位术中出血量更少,253组淋巴结清扫数目更多,差异均有统计学意义(均P<0.05)。两组脾出血事件发生率、淋巴结清扫总数及术后住院时间比较差异均无统计学意义(均P>0.05)。TA组共发生Clavien-DindoⅡ级及以上的术后并发症2例,均为肠梗阻;IMA—CMA组共发生Clavien-DindoⅡ级及以上的术后并发症3例,包括肠梗阻1例、腹腔感染1例、肺栓塞1例。两组Clavien-DindoⅡ级及以上的术后并发症发生率及术后肠梗阻、腹腔感染、肺栓塞的发生率比较差异均无统计学意义(均P>0.05)。两组均无术后腹腔出血病例。结论“肠系膜下动脉优先解剖联合完全内侧入路”结肠脾曲游离技术安全可行,有助于缩短手术时间和减少术中出血量,有利于253组淋巴结充分清扫,且不增加围手术期并发症的发生率。
