右半结肠癌行腹腔镜完整系膜切除外科平面及手术路径研究(附44例报告)  

Surgical plane and surgical path of laparoscopic complete mesocolic excision for right-sided colon cancer

作　　者：欧阳满照[1] 朱达坚[1] 陈小伍[1] 剧永乐[1] 伍锦浩[1] 陆岩[1] 李利红[1] 

机构地区：[1]南方医科大学附属顺德第一人民医院胃肠胰疝外科,广东佛山528300

出　　处：《中国实用外科杂志》2015年第2期187-190,共4页Chinese Journal of Practical Surgery

基　　金：广东省科技计划项目(No.2011B031800036);广东省医学科研基金项目(No.B2013374);佛山市科技计划项目(No.201108191)

摘　　要：目的 探讨右半结肠癌行腹腔镜完整系膜切除（LCME）的外科平面构成和手术路径,并评估其安全性和可行性。方法 回顾性分析2011年1月至2013年12月南方医科大学附属顺德第一人民医院收治的行LCME的44例右半结肠癌病人临床资料,术中观察右半结肠癌LCME外科平面位置、构成和毗邻关系,总结手术路径,分析手术安全性及可行性。结果 44例病人均未发生肠系膜上静脉、十二指肠、输尿管、生殖血管损伤等并发症,术中出血量（73.0±32.3）m L,手术时间（200.0±33.3）min,清扫淋巴结（22.0±9.7）枚,术后首次排气时间（74.0±19.9）h,术后住院时间（10.0±2.2）d;术后无吻合口漏、腹腔脓肿发生。随访6-40个月,中位随访时间为24个月,仅2例术后出现远处转移。结论 按照基于3个外科平面（即升结肠系膜后叶-肾前筋膜间隙、升结肠系膜后叶-胰头十二指肠筋膜前叶间隙、右半横结肠系膜后叶-右侧胃背系膜间隙）的手术路径进行右半结肠癌LCME,可安全有效地达到根治效果。Objective To explore the laparoscopic complete mesocolic excision （LCME） for fight half colon cancer surgical planes composition, paths, the safety and feasibility of the operation path. Methods The clinical data of 44 cases of right-sided colon cancer performed LCME from January 2011 to December 2013 in the First People＇ s Hospital of Shunde Affiliated to Southern Medical University were analyzed retrospectively. The surgical plane＇ s location, composition and adjacent to the relationship between structure of the LCME for right-sided colon cancer during the operations were observed. The operation path, surgical safety and technical feasibility were summarized. Results All the cases did not occur complications such as SMV, duodenum, ureter, reproductive vascular injury. In the operation the average bleeding volume was （73.0± 32.3） mL. The average operative time was （200.0 ± 33.3） rain. The harvest of lymph nodes is （22.0±9.7）. After the operation, there was no anastomotic leakage nor intra-abdominal abscess. The average time for the first exhaust postoperatively was （74.0± 19.9） h, and the average time of postoperative hospital stay is （10.0±2.2）d. All the cases were followed up for 6 to 40 months with median follow-up of 24 months. Only two patients had distant metastases. Conclusion Being familiar with the three surgical planes＇ location, composition and adjacent relationship of LCME for right-sided colon cancer, and based on the operation path, surgeons can reach radical effect of LCME safelyand effectively.

关 键 词：腹腔镜 右半结肠癌 完整结肠系膜切除 外科平面 手术路径 

分 类 号：R6[医药卫生—外科学]