尾侧入路腹腔镜右半结肠癌根治术疗效分析  

Efficacy analysis of laparoscopic radical right hemicolectomy using caudal-to-cranial approach

作　　者：邹瞭南[1] 熊文俊[1] 李洪明[1] 何耀彬[1] 刁德昌[1] 郑燕生[1] 罗立杰[1] 谭萍[1] 王伟[1] 万进[1] 

机构地区：[1]广东省中医院广州中医药大学第二附属医院胃肠外科,510120

出　　处：《中华胃肠外科杂志》2015年第11期1124-1127,共4页Chinese Journal of Gastrointestinal Surgery

摘　　要：目的探讨尾侧入路法（即以肠系膜根部右髂窝附着处与后腹膜愈着的“黄白交界线”为手术入路）实施腹腔镜右半结肠癌根治性切除术的安全性和可行性。方法回顾性分析2014年1月至2015年5月广东省中医院胃肠外科连续收治的行尾侧入路法腹腔镜右半结肠癌根治性切除术的76例患者的临床资料。结果全组76例患者均顺利完成手术，其中1例（1．3％）患者因术中损伤回结肠动脉出血而中转开腹手术。手术时间为（152．8±42．1）min，术中失血量为（70．4±43．5）ml；术后首次排气时间为（49．3±22．9）h，恢复流质饮食时间为（58．5±17．6）h。术后出现并发症者7例（9．2％），其中肺部感染、泌尿系感染、淋巴管瘘各1例．切口感染及炎性肠梗阻各2例，均经保守治疗后痊愈，无术中及术后死亡病例。术后住院时间为（7．8±5．4）d。术后病理结果示：肿瘤直径（4．5±3．2）cm，淋巴结清扫数目（34．2±10．9）枚，其中阳性淋巴结数目（4．1±2．8）枚；肿瘤分期：Ⅰ期8例，ⅡA期14例，ⅡB期22例，ⅡC期2例，ⅢA期15例，ⅢB期12例，ⅢC期3例。结论尾侧入路法腹腔镜右半结肠癌根治性切除术是安全、可行的。Objective To investigate the safety and feasibility of laparoscopic radical right hemicolectomy using caudal-to-cranial approach （yellow-white borderline between right mesostenium and retroperitoneal is firstly cut as the entry to dissect the fusion fascial space between the visceral and parietal peritoneum, which is called caudal-to-cranial approach for right hemicolectomy）. Methods From January 2014 to May 2015, 76 consecutive patients with right side colon cancer underwent laparoscopic radical right hemicolectomy using caudal-to-cranial approach. The baseline characteristics, intraoperative and postoperative outcomes were prospective collected and reviewed retrospectively. Results All the 76 patients completed operations successfully, and one patient （1.3%） was converted to open surgery because of intraoperative bleeding due to unexpected injury of ileocolic artery. The mean operative time was （152.8±42.1） min with a mean estimated blood loss of （70.4±43.5） ml. The mean time of first flatus was （49.3±22.9） h and mean liquid oral intake was （58.5±17.6） h. The postoperative complications appeared in 7 patients （9.2%）, including one （1.3%） of puhnonary infection, one （1.3%） of urinary system infection, two （2.6%） of wound infection, two （2.6%） of inflammatory bowel obstruction and one （1.3%） of lymphatic fistula, and they were all cured with conservative treatments. The postoperative hospital stay was （7.8±5.4） d. The mean number of harvested lymph node was 34.2±10.9, among which 4.1±2.8 was positive. Conclusions Laparoscopic radical right hemicolectomy using caudal-to-cranial approach is safe and feasible.

关 键 词：结肠肿瘤 右半结肠 腹腔镜手术 尾侧入路 临床疗效 

分 类 号：R735.35[医药卫生—肿瘤]