中间入路法腹腔镜右半结肠癌根治术55例临床体会

摘要

Objective:To explore the technique and effect of laparoscopic radical right hemicolectomy in medial-to-lateral ap-proach.Methods:The clinical data of 55 patients with right colon cancer from Jan.2008 to Jan.2013 were retrospectively analyzed.Il-eocolonic vessel was initial approach marker and superior mesenteric vein was anatomic marker,the right surgical plane was established for anatomy of mesenteric vessels and dissection of lymph nodes.Results:Fifty-four cases of laparoscopic-assisted radical right hemico-lectomy were successfully completed,one case was converted to open surgery (1.82%).The average operation time was (113.5 ± 13.8) min and the intraoperative blood loss was (75.2 ±16.5) ml,length of resected specimen was (15.4 ±5.26) cm.The total number of removed lymph nodes was (16 ±3).The average time for exhaust,eating liquid food and hospital stay was (3.5 ±1.8) d, (3.2 ±0.85) d,(9.75 ±1.5) d respectively.No injury of the superior mesenteric vein,duodenum,ureter or genital vessels occurred. No complications were found such as incisional infection,anastomotic leakage,intra-abdominal abscess.The 55 patients were followed up for 10 to 40 months with a mean of (25.5 ±2.3) months,no anastomotic recurrence,implantation or metastasis at the puncture site or assisted incision,distant metastasis.Conclusions:The medial-to-lateral approach with the ileocolonic blood vessels as a surgical mark is quicker and more accurate to enter the Toldt gap and pancreatic duodenal anterior fascia gap.The procedure is safe and guarantees the radical cure of the tumor with high clinical value.%目的：探讨腹腔镜中间入路法右半结肠癌根治术的手术要点及临床疗效。方法：回顾分析2008年1月至2013年1月55例行腹腔镜下右半结肠癌根治术患者的临床资料，术中以回结肠血管为起始入路标志，以肠系膜上静脉为解剖学标志，建立正确的外科平面进行系膜血管的解剖及淋巴结清扫。结果：54例患者均顺利完成腹腔镜辅助根治性右半结肠切除术，1例（1．82％）中转开腹，手术时间平均（113．5±13．8） min，术中出血量平均（75．2±16．5）ml ，切除标本长度平均（15．4±5．26） cm，淋巴结清扫数量平均（16±3）枚，术后排气时间平均（3．5±1．8） d，恢复流质饮食时间平均（3．2±0．85） d，平均住院（9．75±1．5） d。术中无肠系膜上静脉、十二指肠、输尿管、生殖血管损伤，术后无切口感染、吻合口漏、腹腔脓肿等并发症发生。55例患者随访10～40个月，平均（25．5±2．3）个月，未发现吻合口复发、穿刺孔或辅助切口种植转移、远处转移等。结论：以回结肠血管为标志的中间入路法能快速准确地进入Toldt间隙及胰腺十二指肠前筋膜间隙，既能保证肿瘤的根治性，又能保证手术的安全性，具有较高的临床应用价值。