全结肠系膜切除术在腹腔镜辅助右半结肠癌根治术中的应用  

Application of Laparoscopic Complete Mesocolic Excision in Radical Resection for Right Colon Cancer

作　　者：杨卫华[1] 高愫[1] 张松柏[1] 

机构地区：[1]湖北省荆门市第一人民医院胃肠外科,荆门448000

出　　处：《中国微创外科杂志》2015年第4期318-320,328,共4页Chinese Journal of Minimally Invasive Surgery

摘　　要：目的探讨全结肠系膜切除术（complete mesocolic excision,CME）在腹腔镜辅助右半结肠癌根治术中的安全性。方法回顾性分析2012年1月~2013年6月接受CME腹腔镜辅助右半结肠癌根治术40例的临床资料,选取2011年1月~2011年12月同一手术组施行的开腹右半结肠癌根治术38例作为对照组,比较2组患者术中、术后情况。结果腹腔镜组清扫淋巴结（22.1±7.8）枚,明显多于开腹组（18.6±4.3）枚（t=2.436,P=0.017）,其中Ⅱ期淋巴结清扫数目无统计学差异（t=0.758,P=0.454）,Ⅲ期腹腔镜组明显多于开腹组[（23.0±6.0）枚vs.（18.2±5.1）枚,t=2.699,P=0.000]。2组患者手术时间、术中出血量差异无统计学意义（t=0.716,P=0.476;t=-1.547,P=0.126）。腹腔镜组术后引流管拔出时间[（9.0±1.3）d vs.（10.3±2.2）d,t=-2.950,P=0.004],术后排气时间[（3.1±1.2）vs.（4.8±1.4）d,t=-5.767,P=0.000],术后进食时间[（4.3±0.8）d vs.（6.2±1.3）d,t=-7.817,P=0.000],术后住院时间[（10.6±2.8）d vs.（15.8±4.6）d,t=-6.065,P=0.000],术后并发症发生率（10.0%vs.28.9%,χ2=4.504,P=0.034）均显著短于/低于开腹组。结论 CME在腹腔镜辅助下右半结肠癌根治术中安全、可行,可保证切除系膜的完整性和清扫更多的淋巴结,但并不会增加手术风险和术后并发症发生率。Objective To evaluate the safety of laparoscopic complete mesocolic excision（CME） in radical resection for right colon cancer.Methods From January 2012 to June 2013,laparoscopic CME was performed in 40 patients with right colon cancer.Another group of 38 patients underwent traditional radical resection from January 2011 to December 2011.Surgical outcomes were compared between the two groups.Results The number of lymph nodes retrieved in the laparoscopic group（22.1 ± 7.8） was significantly more than that in the traditional group（18.6 ± 4.3,t = 2.436,P = 0.017）.In patients with stage Ⅲ cancer,the laparoscopic group was associated with higher lymph node counts（23.0 ± 6.0 vs.18.2 ± 5.1,t = 2.699,P = 0.000）,however,there were no significant differences in those with stage Ⅱ cancer between the two groups（t = 0.758,P = 0.454）.There were no differences in operation time and intraoperative blood loss between the two groups（t = 0.716,P = 0.476; t =-1.547,P = 0.126）,but in the laparoscopic group the time to pelvic drainage tube removal,time to first flatus,time to liquid diet intake,duration of hospital stay,and postoperative complications were significantly better than those in the traditional group（t =-2.950,P = 0.004;t =-5.767,P = 0.000; t =-7.817,P = 0.000; t =-6.065,P = 0.000; χ2= 4.504,P = 0.034）.Conclusions CME technique in laparoscopic radical right hemicolectomy is feasible,safe,and effective.CME improves the surgical quality with keeping the integrity of mesocolon,more harvested lymph nodes,and not increasing surgical risks and postoperative complications.

关 键 词：全结肠系膜切除术 右半结肠癌根治术 淋巴结清扫 腹腔镜 

分 类 号：R735.35[医药卫生—肿瘤]