腹腔镜下预先断肠并中间尾侧入路在右半结肠全系膜切除术的临床疗效分析  

The Clinical Effect of Laparoscopic Predissection and Middle Caudal Approach in Right Semicolon Total Mesotomy

作　　者：蔡耀庆[1] 郝云鹤 余书勇 陆以亮 高珍 CAI Yao-qing;HAO Yun-he;YU Shu-yong;LU Yi-liang;GAO Zhen(Department of Gastrointestinal Surgery,Hainan Cancer Hospital,Haikou 570100,Hainan,China)

机构地区：[1]海南省肿瘤医院胃肠外科

出　　处：《中国现代手术学杂志》2019年第4期260-263,共4页Chinese Journal of Modern Operative Surgery

摘　　要：目的探讨腹腔镜下预先断肠并中间尾侧入路在右半结肠全系膜切除术的临床疗效。方法 对2015年10月~2018年10月期间在海南省肿瘤医院施行的24例右半结肠癌全系膜切除术及术后结果进行回顾性研究,统计淋巴结清扫数目、手术失血量、手术时间、术后首次排气时间、术后并发症、住院时间等。结果24例患者切除淋巴结总数为492枚,平均(19.6±5.3)枚;平均手术失血量(62.4±42.8)ml;平均手术时间(186.0±21.6)min;术后首次肛门排气时间平均为(3.2±0.7)d;平均术后住院时间(8.4±2.6)d。24例患者中3例发生术后并发症,其中肠梗阻、胃瘫和腹泻各1例,均经对症处理后好转。术后随访11(2~40)个月,2例发生远处转移,余22例均无瘤生存。结论熟悉肠系膜上血管局部解剖,预先断肠并自下而上处理肠系膜上血管,可获得良好的显露,并在适当的操作张力下,使得腹腔镜右半结肠全系膜切除术更为安全可行。Objective To evaluate the clinical effect of laparoscopic right semicolon total mesotomy with predissection and middle caudal approach.Methods A retrospective study was conducted on 24 cases of right colon cancer who had undergone laparoscopic complete mesocolic excision.The number of lymph node dissection,blood loss,operation time,postoperative first exhaust time,postoperative complications and hospital stay were studied.Results There were 492 lymph nodes in all cases,with an average of 19.6±5.3.Surgical blood loss was(62.4±42.8)ml.Operation time was(186.0±21.6)minutes.Postoperative first anal exhaust time was(3.2±0.7)days.Postoperative hospitalization stay was(8.4±2.6)days.There were 3 patients suffered from postoperative complications,including one of intestinal obstruction,one of gastroparesis and one of diarrhea.All of them improved after symptomatic treatment.In the 11(2~40)months follow-up,2 cases relapsed.Conclusions Laparoscopic right semicolon total mesotomy is safe and feasible on the basis of being familiar with the local anatomy of superior mesenteric vessels(SMV),pre-enterotomy and bottom-up treatment of SMV,which can achieve good exposure and appropriate operating tension,and can lead to better dissection of the anatomical hierarchy.

关 键 词：结肠肿瘤 全系膜切除 预先断肠 中间尾侧入路 

分 类 号：R615[医药卫生—外科学]