腹腔镜直肠癌手术中应用中间联合头侧入路疗效分析  

Clinical effects of laparoscopic surgery by medial-cephalo to lateral approach in the treatment of rectal cancer

作　　者：骆洋[1] 俞旻皓[1] 陈建军[1] 秦骏[1] 秦绍岚 仇伊尔 崔然[1] 黄轶洲 钟鸣[1] LUO Yang;YU Min-hao;CHEN Jian-jun(Department of Gastrointestinal Surgery,Ren Ji Hospital,School of Medicine,Shanghai Jiao Tong University,Shanghai 200127,China)

机构地区：[1]上海交通大学医学院附属仁济医院胃肠外科,上海200127

出　　处：《中国实用外科杂志》2018年第9期1064-1067,1080,共5页Chinese Journal of Practical Surgery

基　　金：国家自然科学基金面上项目(No.81672347)：上海市卫生和计划委员会重点项目(No.201540031)

摘　　要：目的探讨中间联合头侧入路在腹腔镜直肠癌手术的临床可行性和应用价值。方法回顾性队列分析上海交通大学医学院附属仁济医院2016年10月至2017年6月间132例腹腔镜直肠癌根治术的临床资料(中间联合头侧组42例,头侧中间组35例,传统中间组55例),比较3组病人术中情况、术后恢复情况以及随访情况的变化。结果在手术时间方面,头侧中间组用时最多[(146.90±5.92)min],其次为中间联合头侧组[(127.50±4.18)min],传统中间组花费时间最少[(122.90±3.97)min](P=0.002);在清扫No.253淋巴结所需时间上传统中间组[(11.91±0.38)min]>中间联合头侧组[(12.24±0.29)min]>头侧中间组[(15.76±0.44)min](P<0.001);No.253淋巴结清扫数目方面,头侧中间组[(2.686±0.220)枚]及中间联合头侧组[(2.929±0.190)枚]均大于传统中间组[(1.709±0.09)枚](P<0.001);而在术中出血量、淋巴结清扫总数以及术后并发症等方面差异无统计学意义。所有病人随访期间无肿瘤复发和转移,无肿瘤相关死亡。结论中间联合头侧入路的腹腔镜直肠癌手术不仅可获得传统中间入路相同的效果,不会增加手术时间和手术难度,而且可以获得和头侧中间入路相似的No.253淋巴结清扫效果。Objective To evaluate the clinical effects of medial-cephalo to lateral approach for laparoseopie radical resection of rectal cancer. Methods The clinical data of 132 rectal cancer patients, undergoing laparoscopic resection of rectal cancer in Renji Hospital, Shanghai Jiao Tong University School of Medicine from October 2016 to June 2017 were analyzed retrospectively, including 42 cases with medial-eephalo to lateral （MCL） group, 35 cases with cephalo-medial to lateral （CML） group, and 55 cases traditional medial-lateral （ML） group. The clinical conditions during operation situations, postoperative situations and follow-up situations were compared among three groups. Results The operative time was the highest in CML group （146.90＋5.92） min, followed by the MCL group（127.50± 4.18） rain and the ML group （122.90±3.97）rain （P=0.002） ;In terms of the time of No.253 lymph node dissected, the CML group was lowest （11.91±0.38 ）rain, followed by the MCL group （12.24±0.29）rain and the ML group （15.76±0.44） min（P 〈 0.001 ） ; Compared the number of No.253 lymph node dissected in the three group. The CML group was the best （2.929~0.190） , followed by MCL group （2.686-＋0.220）and CM group （1.709-＋0.090）（P 〈 0.01 ）. While in other cases, such as volume of intraoperative blood loss, number of lymph node dissected and postoperative complications were no significant difference in the three group.Tumor recurrence, metastasis, and tumor-free death occurred during follow-up in all patients. What＇ s more, all patients had no tumor recurrence, no distant metastasis and no tumor-related death during follow-up. Conclusion The medial-cephalo to lateral approach is safe and feasible for laparoscopic radical resection of rectal cancer, and an advantage of No.253 lymph node dissection, which cannot extend the operation time.

关 键 词：腹腔镜直肠癌手术 中间联合头侧入路 头侧中间入路 淋巴结清扫 

分 类 号：R6[医药卫生—外科学]