完整结肠系膜切除在腹腔镜左半结肠癌根治术中应用分析  

Laparoscopic complete mesocolic excision(CME) for left-sided colon cancer: analysis of feasibility and technical tips

作　　者：宗雅萍[1] 韩丁培[1] 陆爱国[1] 冯浩[1] 张卓[1] 马君俊[1] 冯波[1] 薛佩[1] 王明亮[1] 郑民华[1] 

机构地区：[1]上海交通大学医学院附属瑞金医院普通外科上海市微创外科临床医学中心,上海200025

出　　处：《中国实用外科杂志》2014年第1期85-89,共5页Chinese Journal of Practical Surgery

摘　　要：目的探讨全结肠系膜切除(complete mesocolic excision,CME)在腹腔镜左半结肠癌根治术中应用的可行性。方法回顾性分析上海交通大学医学院附属瑞金医院普外科2010年9月至2012年12月在腹腔镜左半结肠癌根治术中行CME31例病人的临床资料及相关手术视频图片资料;采用手术分级系统评价手术质量;分析手术安全性及可行性,探讨腹腔镜CME左半结肠癌根治术的解剖层次及技术要点。结果均以中间入路完成腹腔镜CME左半结肠癌根治术,超声刀锐性分离脏壁层筋膜,保持结肠系膜完整性,达到血管根部结扎;手术平均时间(106±15)min,平均出血量(105±74)mL,平均住院时间(11.1±2.8)d,术后发生并发症4例(12.9%)。手术质量等级评估A级28例,B级3例,淋巴结清扫总数为(13.9±5.0)枚,Ⅲ期病人中,中央组淋巴结阳性率15.8%(3/19)。结论腹腔镜CME左半结肠癌根治术安全可行;远期疗效有待进一步研究。Objective To investigate the feasibility and technical tips of laparoscopic complete mesocolic excision （CME） for left-sided colon cancer. Methods The clinicopathological data of 31 cases with left-sided colon cancer underwent laparoscopic CME between September 2010 and December 2012 in our center was analyzed retrospectively. The quality of surgery was staged by the system reported by West, anatomic planes and technical tips were also elucidated by pictures and videos. Results All the 31 cases were successfully performed laparoscopie CME. Sharp dissection of the visceral plane from somatic one was performed to keep the integrity of mesocolon. Central ligation of the supplying vessels was needed to obtain an increased lymph node removal. The mean operative time was 106_＋ 15 min and the blood loss was 105_＋74 ml. The mean time for hospitalization were 11.1 ±2.8 days. Complications were observed in 4 cases （12.9%）. 28 cases were evaluated pathologically as Grade A and 3 were Grade B. The total number of lymph nodes removed was 13.9±5.0. In the cases of stage III, the positive rate of principle lymph nodes was 15.8% （3/19cases）. Conclusions Laparoscopic CME for left-side colon cancer with medial access is technically feasible and randomized trials are needed to evaluate its long-term outcomes.

关 键 词：完整结肠系膜切除 左半结肠癌 腹腔镜结肠切除术 

分 类 号：R6[医药卫生—外科学]