混合入路在腹腔镜左半结肠癌根治术中的应用价值  

Application value of hybrid approach in laparoscopic radical resection of left hemicolon cancer

作　　者：张广坛 薛飞[1] 郑晓艳 宋玉成 袁远 宋笑飞 张鹏[1] 郭宇 张学东 Zhang Guangtan;Xue Fei;Zheng Xiaoyan;Song Yucheng;Yuan Yuan;Song Xiaofei;Zhang Peng;Guo Yu;Zhang Xuedong(School of Clinical Mediciney Henan University,Department of Gastrointestinal Surgeryy Henan Provincial People's Hospital,Zhengzhou 450003,China)

机构地区：[1]河南大学临床医学院河南省人民医院胃肠外科,郑州450003

出　　处：《中华消化外科杂志》2020年第3期330-335,共6页Chinese Journal of Digestive Surgery

基　　金：河南省科技攻关项目(182300410298)。

摘　　要：目的:探讨混合入路在腹腔镜左半结肠癌根治术中的应用价值。方法:采用回顾性描述性研究方法。收集2015年1月至2018年3月河南省人民医院收治的96例左半结肠癌患者的临床病理资料;男52例,女44例;平均年龄为61岁,年龄范围为29~75岁。患者均施行腹腔镜左半结肠癌根治术。观察指标:(1)手术和术后恢复情况。(2)术后病理学检查情况。(3)术后化疗情况。(4)随访情况。采用门诊及电话方式进行随访,了解患者术后生存、肿瘤复发和转移情况。随访时间截至2019年10月。偏态分布的计量资料以M(范围)表示,计数资料以绝对数表示。结果:(1)手术和术后恢复情况:96例患者均采用混合入路施行腹腔镜左半结肠癌根治术。96例患者中,5例行腹腔镜联合多器官切除术(2例联合脾切除术、2例联合胃壁楔形切除术、1例联合脾脏和胰体尾切除术);7例行手助腹腔镜手术(5例因肿瘤侵犯需行多器官切除术、2例因近端肠管梗阻严重无法暴露加行回肠末端造瘘术);84例行腹腔镜辅助手术;无中转开腹。96例患者中,3例行回肠后方吻合,2例行旋转升结肠吻合,91例行原位吻合。96例患者手术时间为140 min(70~250 min),术中出血量为50 mL(30~140 mL);术后首次肛门排气时间为2 d(1~4 d)。96例患者中,术后5例切口感染,5例肺部感染,3例粘连性肠梗阻,1例吻合口瘘,均经保守治疗治愈。96例患者术后住院时间为8 d(5~27 d)。(2)术后病理学检查情况:96例患者清扫淋巴结数目为19枚(13~25枚);手术切除标本长度为35 cm(25~50 cm),切缘均为阴性。96例患者病理学T分期:pT1期5例,pT2期46例,pT3期37例,pT4期8例;病理学N分期:pN0期32例,pN1期47例,pN2期17例。96例患者均为M0期,无远处转移。96例患者病理学类型:黏液腺癌7例,低分化腺癌16例,中分化腺癌46例,高分化腺癌27例。(3)术后化疗情况:96例患者中,68例术后行奥沙利铂+卡培他滨方案规范化Objective To investigate the application value of hybrid approach in laparoscopic radical resection of left hemicolon cancer.Methods The retrospective and descriptive study was conducted.The clinicopathological data of 96 patients with left hemicolon cancer who were admitted to Henan Provincial People′s Hospital between January 2015 and March 2018 were collected.There were 52 males and 44 females,aged from 29 to 75 years,with an average age of 61 years.Patients underwent laparoscopic radical resection of left hemicolon cancer.Observation indicators:(1)surgical situations and postoperative recovery;(2)postoperative pathological examination;(3)postoperative chemotherapy;(4)follow-up.Follow-up using outpatient examination and telephone interview was performed to detect postoperative survival,tumor recurrence and metastasis of patients up to October 2019.Measurement data with skewed distribution were represented as M(range),and count data were described as absolute numbers.Results (1)Surgical situations and postoperative recovery:all the 96 patients underwent laparoscopic radical resection of left hemicolon cancer with hybrid approach.Of 96 patients,5 underwent laparoscopic multiple organ resection including 2 combined with splenectomy,2 combined with gastric wall wedge resection,1 combined with splenectomy and distal pancreatectomy;7 underwent hand-assisted laparoscopic surgery including 5 undergoing multiple organ resection due to tumor invasion,2 combined with terminal ileostomy due to poor exposure caused by severe obstruction in proximal intestinal canal;84 underwent laparoscopic-assisted surgery.There was no intraoperative conversion to laparotomy.Of 96 patients,3 received posterior ileum anastomosis,2 received rotating ascending colon anastomosis,91 received in situ anastomosis.Operation time,volume of intraoperative blood loss,and time to first flatus were 140 minutes(range,70-250 minutes),50 mL(range,30-140 mL),2 days(range,1-4 days),respectively.Of 96 patients,5 had postoperative incision infection,5 had

关 键 词：结肠肿瘤 结肠切除术 手助腹腔镜手术 手术入路 吻合方式 腹腔镜检查 

分 类 号：R735[医药卫生—肿瘤]