中间尾侧联合入路行腹腔镜D3淋巴结清扫加完整结肠系膜切除术治疗右半结肠癌合并不全性肠梗阻的安全性和可行性  

Safety and feasibility of the combined medial and caudal approach in laparoscopic D3 lymphadenectomy plus complete mesocolic excision for right hemicolectomy in the treatment of right hemicolon cancer complicated with incomplete ileus

作　　者：陈庆永 帅晓明[2] 陈立波[1] Chen Qingyong;Shuai Xiaoming;Chen Libo(Department of Emergency Medicine,Union Hospital,Tongji Medical College,Huazhong University of Science and Technology,Wuhan,Hubei 430022,China（Chen QY,Chen LB;Department of Gastrointe.stinal Surgery,Union Hospital,Tongji Medical College,Huazhong University of Science and Technology,Wuhan,Hubei 430022,Chiua（Shuai XM)

机构地区：[1]华中科技大学同济医学院附属协和医院急诊外科,武汉430022 [2]华中科技大学同济医学院附属协和医院胃肠外科,武汉430022

出　　处：《中华胃肠外科杂志》2018年第9期1039-1044,共6页Chinese Journal of Gastrointestinal Surgery

摘　　要：目的探讨中间尾侧联合人路行腹腔镜D3淋巴结清扫加完整结肠系膜切除术（CME）治疗右半结肠癌合并不全性肠梗阻的安全性和可行性。方法采用回顾性队列研究方法，收集2014年6月至2017年6月期间．华中科技大学同济医学院附属协和医院急诊外科及胃肠外科收治，并行腹腔镜有半结肠切除术（D3淋巴结清扫加CME）治疗的65例经腹部CT增强扫描或MRI和（或）电子结肠镜确诊为右半结肠癌（T1-4M0）并不全性肠梗阻患者的临床资料。其中中间尾侧联合人路33例（中间尾侧联合人路组），头侧中间人路32例（头侧中间人路组）。中间尾侧联合人路组手术要点：（1）先中间人路解剖肠系膜上静脉（SMV），紧贴SMV向上解剖分离，清扫血管前方及右侧淋巴脂肪组织。（2）然后尾侧人路切开末端回肠的背侧系膜，以十二指肠水平部为标志，沿Toldt间隙向头侧分离右腹膜后间隙，把胰头前间隙及右Toldt间隙分离出来。（3）最后再中间人路在SMV左侧根部离断并结扎回结肠血管、结肠中血管及右结肠血管，清扫根部淋巴结，处理Henle于各属支。比较两组患者术中及术后并发症情况。结果65例右半结肠癌合并不全性肠梗阻患者中，男38例，女27例，年龄31～72（56．8±11．7）岁。中间尾侧联合人路组与头侧中间人路组患者一般资料的差异无统计学意义（均P〉0．05）。中间尾侧联合人路组患者术中出血量较头侧中间人路组患者术中出血量减少[（106．5±24．5）m1比（308．4±27．1）ml，t=-31．501．P=0．000]，手术时间缩短[（176．3±18．0）min比（208．4±47．3）min，t=-3．602，P=0．001]，两组中间人路组淋巴结清扫数[（22．5±8．9）枚比（21．5±7．6）枚]、淋巴结清扫数目≥12枚的患者比例[（87．9％（29／33）比84．4％（27／32）]、术后并发症发生率[6．1％（2／33）比12．5％（4�Objective To explore the safety and feasibility of the combined medial and caudal approach in laparoseopie D3 lymphadeneetomy plus complete mesoeulie excision （CME） for right hemicoleetoiny in the treatment of right hemicolon cancer complicated with incomplete ileus. Methods Clinical data of 65 patients with incomplete obstructive right-sided colon cancer （T1 to 4M0） diagnosed by abdominal CT enhanced scan or MRI and/or electric colonscope undergoing laparoscopic right hemicoleetomy （1）3 lymphadenectomy ＋ CME） at Department of Emergency Medicine and Department of Gastrointestinal Surgery from June 2014 to June 2017 were retrospectively analyzed. Among them, 33 patients received the combined medial and caudal approach （combined medial and caudal approach group） and the other 32 patients received the cephalo medial-to-lateral approaeh （eephalo medial-to- lateral approach group）. The operation highlights of the combined medial and caudal approach group were as follows： （1） The superior mesenteric vein （SMV） was first identified and exposed using the combined medial and caudal approach, and lymph node dissection along the anterior and right of SMV was performed. （2） With horizontal part of duodenum as landmarks, the dorsal mesenterie membrane of terminal ileum was opened by caudal-to-cranial approach, and right retroperitoneal space along the Toldt＇s space was separated. The anterior of pancreatic head and the right Toldt＇s space were then exposed. （3） Finally using medial-to-lateral approach, the roots of ileocolic vessels, middle colic vessel amt right colic vessel were disconnected and ligated along the left border of SMV. The right branch of gastrocolie trunk of Henle was ligated and lymph node dissection along SMV was performed again. Patients in cephalo medial-to-lateral approach group underwent conventional operation. Baseline informatiun, intraoperative blood loss, operation time, number of harvested lymph nodes, proportion of no less than 12 harvested lymph nodes

关 键 词：结肠肿瘤 右半结肠 不全性肠梗阻 右半结肠切除术 完整结肠系膜切除术 D3淋巴结清扫 中间尾侧联合入路 

分 类 号：R735.35[医药卫生—肿瘤]