完全3D腹腔镜以血管为导向中间入路右半结肠癌根治术的临床体会  

Complete 3D laparoscopic vascular-guided middle approach for radical resection of right colon cancer

作　　者：胡小忍 向甫 徐雪东[1] 张伟国[1] 王嘉[1] 陈瑶[1] 王景超 安伟德[1] HU Xiao-ren;XIANG Fu;XU Xue-dong(Department of General Surgery,the First Affiliated Hospital of Dalian Medical University,Dalian 116600,China)

机构地区：[1]大连医科大学附属第一医院普通外科,辽宁大连116600

出　　处：《腹腔镜外科杂志》2020年第8期577-581,共5页Journal of Laparoscopic Surgery

摘　　要：目的:探讨完全3D腹腔镜下采用以血管为导向的中间入路行右半结肠癌根治术的安全性。方法:回顾2018年12月至2019年12月施行的38例完全3D腹腔镜下以血管为导向的中间入路右半结肠癌根治术的临床资料。由中间入路解剖出肠系膜上静脉各属支,根部结扎离断,由内向外、自下而上分离右侧Toldt间隙及横结肠后间隙,切开胰颈部横结肠系膜前叶,离断横结肠,再由上向下、由内到外完整切除右半结肠系膜,最后采用腔内直线切割闭合器行回结肠侧侧吻合。结果:38例均顺利完成完全3D腹腔镜下右半结肠癌根治术,完整切除右半结肠系膜,根部结扎血管,彻底清扫淋巴结,无术中并发症发生。手术时间平均(140.7±11.4)min,术中出血量19(13.75,30)mL。术后发生并发症5例,包括吻合口漏1例,肺部感染3例,取标本切口感染1例。术后随访6~18个月,平均(10.0±3.1)个月,无吻合口狭窄,2例复发,其中1例出现腹膜转移。结论:完全腹腔镜下采用以血管为导向的中间入路行右半结肠癌根治术安全、可行。Objective:To explore the safety of right-sided colon cancer radical resection by blood vessel-guided middle approach under complete 3D laparoscopy.Methods:The clinical data of 38 patients with totally 3D laparoscopic vascular-guided radical approach for right colon cancer undergoing radical surgery from Dec.2018 to Dec.2019 were retrospectively analyzed.The branches of the superior mesenteric vein were dissected from the middle approach and the vascular roots were ligated and cut off.From the inside to the outside,the right Toldt space and the posterior transverse colon space were separated from the bottom to the top.The transverse colon was cut off,and then the mesentery of the right colon was completely removed from top to bottom,from the inside to the outside.Finally,the side-to-side ileocolonic anastomosis was performed by an articulating endoscopic linear cutter.Results:All 38 patients successfully underwent complete 3D laparoscopic radical resection of right colonic carcinoma with complete removal of right mesenteric colon,root ligation of blood vessels,and thorough lymph node dissection without intraoperative complications.The operative time was(140.7±11.4)min,and the intraoperative blood loss was 19(13.75,30)mL.There were 5 cases of postoperative complications,including 1 case of anastomotic leakage,3 cases of lung infection,and 1 case of infection at incision,which was used to remove the specimen.After follow-up of(10.0±3.1)months(range 6-18 months),there was no anastomotic stenosis.There were 2 cases of recurrence,and one of them had peritoneal metastasis.Conclusions:It is safe and feasible to perform complete laparoscopic radical surgery for right colonic cancer via blood vessel-guided middle approach.

关 键 词：结肠肿瘤 右半结肠癌根治术 腹腔镜检查 中间入路 成像 三维 

分 类 号：R735.35[医药卫生—肿瘤]