腹腔镜下保留植物神经右半结肠癌D3根治术的可行性及应用价值  

Feasibility and application value of autonomic nerve-preserving D3 radical resection for right- sided colon cancer under laparoscope

作　　者：刁德昌 万进 易小江 卢新泉 王伟[1] 李洪明 熊文俊 何耀彬 Diao Dechang;Wan Jin;Yi Xiaojiang;Lu Xinquan;Wang Wei;Li Hongming;Xiong Wenjun;He Yaobin(Department of Gastrointestinal Surgery,The Second Affiliated Hospital of Guangzhou University of Chinese Medizinc（Guangdong Province Hospital of Traditional Chinese Medicine）,Guangzhou 510120,China)

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

出　　处：《中华胃肠外科杂志》2018年第8期908-912,共5页Chinese Journal of Gastrointestinal Surgery

摘　　要：目的探讨腹腔镜下保留植物神经功能的右半结肠癌根治术的可行性及应用价值。方法采用回顾性队列研究方法分析2016年1月至2017年7月在广东省中医院胃肠外科接受腹腔镜D3淋巴结清扫加完整结肠系膜切除手术的55例右半结肠癌患者的临床资料。排除因各种原因行急诊手术、合并肠梗阻或穿孔、有肿瘤转移或局部晚期、既往有腹部手术史以及术前行放化疗的患者。其中29例于肠系膜上动脉（SMA）鞘内淋巴结清扫，切除部分肠系膜上神经丛（神经部分切除组）；26例于SMA鞘外清扫[在血管鞘外间隙内用锐性和钝性相结合的方法清扫SMA中线右侧的淋巴脂肪组织：在SMA动脉鞘与SMV交界处进入肠系膜上静脉（SMV）血管鞘，在鞘内裸化SMV，完成第3站淋巴结的整块清扫]，完全保留肠系膜上神经丛（神经保留组）。比较两组患者术中、术后恢复及并发症发生情况。结果两组患者基线资料比较，差异均无统计学意义（均P〉0．05）。神经保留组手术时间为（164．0±19．8）min，较神经部分切除组（176．0±19．7）min明显缩短（t=2．249，P=0．029），两组术中出血量、术中血管损伤、术后排气时间及术后住院时间等其他围手术期指标的差异均无统计学意义（均P〉0．05）。两组患者淋巴结清扫数量分别为（28．5±7．8）枚和（27．6±6．5）枚，差异无统计学意义（P〉0．05）。神经保留组较神经部分切除组患者乳糜漏发生率[3．8％（1／26）tt37．9％（11／29），χ^=9．337，P=0．002]和术后腹泻比例[15．4％（4／26）比41．4％（12／29），χ^2=4．491，P=0．034]均显著降低。结论保留植物神经的右半结肠癌根治术安全可行，可有效预防因神经损伤而导致的术后胃肠功能紊乱的发生，并减小乳糜漏的发生风险。Objective To explore the feasibility and application value of the preservation of vegetative nervous functions in radical resection for right-sided colon cancer. Methods Clinical data of 55 cases with right-sided colon cancer undergoing laparoseopic D3 ＋ complete mesocolic excision （CME） radical resection from January 2016 to July 2017 at Department of Gastrointestinal Surgery of Guangdong Province Hospital of Traditional Chinese Medicine were retrospectively analyzed. Exclusion criteria included emergency surgery for various reasons, intestinal obstruction or perforation, distant metastasis or locally advanced cancer, previous history of abdominal surgery and preoperative rleoadjuvant chemoradiotherapy. Twenty-nine cases underwent lymphadenectomy with intrathecal dissection of superior mesenteric artery （SMA） and part of superior mesenteric plexus was resected （nerve partial resection group, NPR group）. Twenty-six cases received lymphadenectomy with the clearance of lymphatic adipose tissue on the right side of SMA by sharp or obtuse method outside the sheath; the sheath of superior mesenteric vein （SMV） was entered at the junction of SMA and SMV; the SMV was naked in the sheath; the third station lymph node dissection was completed with preservation of superior mesenteric plexus （nerve preserved group, NP group）. Intra-operative and postoperative complications were compared between two groups. Results The baseline data were not significantly different between two groups （all P〉0.05）. The operation time in NP group was significantly shorter than that in NPR group [（164.0±19.8） minutes vs. （176.0±19.7） minutes, t=2.249, P=0.029]. No significant differences in operative blood loss, operative vessel damage, postoperative time to flatus, postoperative hospital stay and abdominal pain were observed between two groups （all P〉0.05）. The number of harvested lymph node in two groups was 28.5±7.8 and 27.6±6.5 respectively without significant difference （P〉0.05）. As compa

关 键 词：右半结肠肿瘤 D3淋巴结清扫 腹腔镜 完整结肠系膜切除术 植物神经 胃肠功能紊乱 乳糜漏 

分 类 号：R735.35[医药卫生—肿瘤]