腹腔镜右半结肠癌完整系膜切除术经尾侧-中间联合入路回顾性研究  

A retrospective study on laparoscopic complete mesocolic excision via dorsal-medial hybrid approach for right colon cancer

作　　者：刘海山 蔡正昊 马君俊[1] 孙晶[1] 何子锐[1] 臧潞[1] 董峰[1] 冯波[1] 宗雅萍[1] 薛佩[1] 张鲁阳[1] 陆爱国[1] 郑民华[1] LIU Haishan;CAI Zhenghao;MA Junjun;SUN Jing;HE Zirui;ZANG Lu;DONG Feng;FENG Bo;ZONG Yaping;XUE Pei;ZHANG Luyang;LU Aiguo;ZHENG Minhua(Department of Surgery,Ruijin Hospital,Shanghai Jiao Tong University School of Medicine,Shanghai 200025,China)

机构地区：[1]上海交通大学医学院附属瑞金医院外科,上海200025

出　　处：《外科理论与实践》2020年第3期211-216,共6页Journal of Surgery Concepts & Practice

基　　金：促进市级医院临床技能与临床创新三年行动计划重大疾病临床技能提升项目(16CR1011A)。

摘　　要：目的 :比较腹腔镜右半结肠癌完整系膜切除术(complete mesocolic excision, CME)经尾侧-中间联合入路(简称尾侧联合入路)与传统中间入路(简称中间入路)在手术学、肿瘤学等方面的效果。方法 :回顾性分析2017年1月至6月收治的68例右半结肠癌病人。根据手术入路分为尾侧联合入路组37例及中间入路组31例。采用West分级系统评估比较两组的CME完成质量以及手术安全性、术后近期疗效及远期预后。结果:病人均经CME完成质量评估。尾侧联合入路组CME完成率为86.5%,中间入路组CME完成率为80.6%。两组间差异无统计学意义(P=0.53)。尾侧联合入路组腹腔镜下解剖时间较中间入路缩短[(62.70±12.22) min比(70.39±11.98) min,P=0.01]。两组病人总手术时间、术中出血量、术后排气时间、术后并发症发生及远期预后差异均无统计学意义。结论:腹腔镜右半结肠癌CME,经尾侧联合入路可缩短腹腔镜下解剖时间,CME完成质量、安全性、预后两种手术入路相当。Objective To investigate pathologic effects combined with postoperative results on right colon cancer with laparoscopic complete mesocolic excision(CME)via dorsal-medial hybrid approach compared with traditional medial approach.Methods A total of 68 patients with right colon cancer undergoing laparoscopic CME in our hospital between January and June 2017 were studied retrospectively.There were two groups including 37 cases in dorsal-medial hybrid group and 31 cases in traditional medial group.CME quality evaluated with the method proposed by West et al along with safety,short-term results and long-term prognosis were compared between two groups.Results CME completion rate was 86.5%in dorsal-medial hybrid group and 80.6%in traditional medial group without statistical difference(P=0.53).Laparoscopic dissection time in dorsal-medial group was significantly shorter than that in traditional medial group[(62.70±12.22)min vs.(70.39±11.98)min,P=0.01].There was no statistical difference in operation time,blood loss,postoperative flatus time,postoperative complications and long-term prognosis of the patients between two groups.Conclusions Laparoscopic CME via dorsal-medial hybrid approach for right colon cancer could have less laparoscopic dissection time,and two approaches were similar in CME quality,safety and prognosis.

关 键 词：结肠癌 结肠完整系膜切除术 腹腔镜右半结肠癌根治术 尾侧-中间联合入路 传统中间入路 

分 类 号：R735.35[医药卫生—肿瘤]