腹腔镜下横结肠癌全结肠系膜切除术的临床应用  

Clinical application of laparoscopic complete mesocolic excision for transverse colonic carcinoma

作　　者：肖宝来[1] 蒋雪峰[1] 胡小苗[1] 向进见[1] 谢建平[1] 田夫[1] XIAO Bao-lai JIANG Xue- feng HU Xiao-miao et al(Department of General Surgery, First People＇s Hospital of Jiugzhou, First Hospital Affiliated to Changjiang University, Jingzhou 4？4000, Chin)

机构地区：[1]荆州市第一人民医院,长江大学附属第一医院,湖北荆州434000

出　　处：《腹腔镜外科杂志》2016年第10期764-767,共4页Journal of Laparoscopic Surgery

摘　　要：目的：探讨腹腔镜下横结肠癌全结肠系膜切除术的临床处理技巧,以提高手术安全性及短期疗效。方法：回顾分析2009年6月至2013年12月行腹腔镜横结肠癌全结肠系膜切除术的31例患者的临床资料。结果：2例患者中转开腹,29例在腹腔镜下完成手术。手术时间85-290 min,平均（140.0±28.6）min;术中出血量25-550 ml,平均（80.0±33.0）ml;术后排气时间2-7 d,平均（2.5±1.3）d;引流量55-450 ml,平均（83.0±24.6）ml;术后开始进食时间2-6 d,平均（2.5±1.2）d;淋巴结清扫数量9-33枚,平均（14.6±3.5）枚;术后住院7-21 d,平均（9.0±3.6）d。术后并发肠梗阻、肺部感染、切口感染各1例,均经保守治疗后治愈,无吻合口漏发生。结论：腹腔镜下横结肠癌全结肠系膜切除术中精细操作注意层面,熟悉常见解剖及变异,具有一定的腹腔镜操作技巧,是安全、有效的,在发挥微创手术优势的同时不增加手术相关风险。Objective： To explore the clinical treatment skills of the laparoscopic complete mesocolic excision for transverse colonic carcinoma,in order to improve the operative safety and the short-term curative effect.Methods： A retrospective analysis was made on the clinical data of 31 patients who underwent laparoscopic complete mesocolic excision for transverse colonic carcinoma from Jun.2009 to Dec.2013.Results： All operations were successfully completed,2 patients were converted to laparotomy,the rest of the 29 laparoscopic surgeries were completed.The average operation time was（ 140.0 ± 28.6） min（ range,85-290 min）,the average intraoperative blood loss was（ 80.0 ± 33.0） ml（ range,25-550 ml）,the average postoperative exhaust time was（ 2.5 ± 1.3） d（ range,2-7 d）,the average volume of drainage was（ 83.0 ± 24.6） ml（ range,55-450 ml）,the average postoperative diet time was（ 2.5 ± 1.2） d（ range,2-6 d）,the average number of harvested lymph node was（ 14.6 ± 3.5）,ranged from 9 to 33; the average hospital stay was（ 9.0 ± 3.6） d（ range,7-21 d）.One case of intestinal obstruction,one case of pulmonary infection and one case of incision infection were found after operation,which were cured after conservative treatment.No anastomotic leakage occurred.Conclusions： Laparoscopic complete mesocolic excision for transverse colonic carcinoma can be safely and effectively completed,this precedure will become the development trend of the transverse colon cancer surgery.On the basis of careful operation,familiar common anatomy and variation,skilled laparoscopic operation,this procedure has advantage of mini-invasion,and at the same time,does not increase the risk associated with surgery.

关 键 词：结肠肿瘤 全结肠系膜切除术 腹腔镜检查 

分 类 号：R735.35[医药卫生—肿瘤]