以回结肠静脉为标记中线入路并左手控制技术在右半结肠切除术中的应用  

The clinical application of midline approach marked by ileocolonic vein and left hand controlled technology in the right hemicolectomy

作　　者：蔡耀庆[1] 韩广森[2] 张健[2] 刘远廷[2] 

机构地区：[1]河北联合大学附属唐山肿瘤医院普外科,河北唐山063000 [2]河南省肿瘤医院普外科,河南郑州450003

出　　处：《中国肿瘤外科杂志》2013年第5期280-283,共4页Chinese Journal of Surgical Oncology

摘　　要：目的探讨以回结肠静脉为标记中线入路并左手控制技术在右半结肠切除术中的应用。方法对2011年10月至2012年10月18例以回结肠静脉为标记中线入路并左手控制技术(观察组:自下而上处理肠系膜上静脉)右半结肠切除术患者资料进行回顾性分析,并与同期实施以肠系膜上静脉为标记中线入路(对照组:自上而下处理肠系膜上静脉)右半结肠切除术的20例患者的手术时间、术中出血量、手术效果及安全性进行比较。结果观察组与对照组平均手术时间分别为(46.7±6.3)min及(106.5±12.7)min,差异有统计学意义(P=0.024);术中平均出血量分别为(55.8±9.4)mL和(60.5±11.5)mL,差异无统计学意义(P=0.35)。观察组无肠系膜上静脉损伤病例,对照组2例患者出现肠系膜上静脉损伤。观察组淋巴结清扫数平均(11.4±5.5)个,对照组淋巴结清扫数平均(10.2±4.7)个,观察组和对照组清扫淋巴结效果相当(P=0.83),差异无统计学意义。结论以回结肠静脉为标记中线入路并左手控制技术能够减少肠系膜上静脉损伤机会,降低手术难度,缩短手术时间,增加手术安全性。Objective To explore the clinical application of midline approach marked by ileocolonic vein and left hand controlled technology in the right hemicolectomy. Methods 18 cases which marked by ileocolou- ic vein of center line approach and left hand controlled technology were retrospectively analyzed and compared with control group which treated superior mesenteric vein （SMV） from the bottom up, and compared with superi- or mesenteric vein treated from the top down group of 20 cases. Results The average operation time of the ob- servation group and control group were 41 to 75 （46.7 ± 6.3 ） rain,95 to 140 （ 106.5 ± 12.7） rain, respective- ly. Operative bleeding were 30 to 100 （55.8 ± 9.4） ml and 35 to 110 （60.5 ± 11.5） ml. The differences in operative time was significant statistically （ P = 0. 024 ） , while the intraoperative blood loss was no significant difference statistically （P = 0.35 ）. The observation group had no superior mesenteric vein injury cases, while there was 2 cased occurred in the controlled group. The lymphadenectomy number of observation group were av- erage of （ 11.4 ± 5.5 ） , and the control group lymph node dissection was average of （ 10.2 ± 4.7 ）, there was no significant difference statistically. Conclusions Midline approach marked by ileocolic vascular combined with left hand controlled technology can reduce SMV damage opportunities to reduce the difficulty of operation, shorter operation time and increase surgical safety.

关 键 词：结肠肿瘤 右半结肠切除 回结肠静脉 中线入路 左手控制 

分 类 号：R656.9[医药卫生—外科学]