“三三制分离法”应用于腹腔镜右半结肠癌根治术的近期疗效  

Shor⁃term effects of laparoscopic right hemicolon cancer radical resection with‘the three approaches in separation’

作　　者：张广坛 王志霞 宋玉成 袁远 宋笑飞 张鹏[1] 郭宇 张学东 Zhang Guangtan;Wang Zhixia;Song Yucheng;Yuan Yuan;Song Xiaofei;Zhang Peng;Guo Yu;Zhang Xuedong(School of Clinical Medicine,Henan University,Department of Gastrointestinal Surgery,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12期1318-1323,共6页Chinese Journal of Digestive Surgery

基　　金：河南省医学科技攻关计划项目(LHGJ20190598)。

摘　　要：目的探讨“三三制分离法”应用于腹腔镜右半结肠癌根治术的近期疗效。方法采用回顾性描述性研究方法。收集2018年12月至2019年12月河南省人民医院收治的57例右半结肠癌患者的临床病理资料;男32例,女25例;中位年龄为68岁,年龄范围为21~81岁。患者均施行腹腔镜辅助右半结肠癌根治术。观察指标:(1)手术和术后恢复情况。(2)术后病理学检查情况。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:57例患者均采用“三三制分离法”行腹腔镜辅助右半结肠癌根治术,无中转开腹。57例患者中,5例联合行腹腔镜多器官切除术(2例联合胃壁楔形切除术、2例联合十二指肠壁部分切除术、1例联合胆囊切除术)。57例患者术中留置鼻肠管,术后给予肠内营养,十二指肠周围留置双套管持续冲洗吸引。57例患者手术时间为110 min(80~230 min),术中出血量为50 mL(10~130 mL);术后首次肛门排气时间为2 d(1~3 d)。57例患者中,术后4例切口感染,3例肺部感染,1例粘连性肠梗阻,均经保守治疗治愈。57例患者术后住院时间为7 d(5~17 d)。(2)术后组织病理学检查情况:57例患者淋巴结清扫数目为21枚(13~27枚);手术切除标本长度为30 cm(25~50 cm),切缘均为阴性。57例患者病理学T分期:pT1期5例,pT2期23例,pT3期24例,pT4期5例;病理学N分期:pN0期17例,pN1期27例,pN2期13例。57例患者均为M0期,无远处转移。57例患者病理学类型:黏液腺癌7例,低分化腺癌5例,中分化腺癌18例,高分化腺癌27例。结论“三三制分离法”应用于腹腔镜右半结肠癌根治术中安全、可行。Objective To investigate the short⁃term effects of laparoscopic right hemicolon cancer radical resection with‘the three approaches in separation’.Methods The retrospective and descriptive study was conducted.The clinicopathological data of 57 patients with right hemicolon cancer who were admitted to Henan Provincial People′s Hospital between December 2018 and December 2019 were collected.There were 32 males and 25 females,aged from 21 to 81 years,with a median age of 68 years.Patients underwent laparoscopic assisted radical resection of right hemicolon cancer.Observation indicators:(1)surgical situations and postoperative recovery;(2)postoperative histopathological examination.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 57 patients underwent laparoscopic radical resection of right hemicolon cancer with‘the three approaches in separation’.There was no intraoperative conversion to laparotomy.Of 57 patients,5 underwent laparoscopic multiple organ resection including 2 combined with gastric wall wedge resection,2 combined with partial duodenectomy and 1 combined with splenectomy.During operation,57 patients underwent nasointestinal tube indwelling for postoperative enteral nutrition,and double cannula placeing around duodenum for continuous irrigation and suction.Operation time,volume of intraoperative blood loss,and time to first flatus were 110 minutes(range,80-230 minutes),50 mL(range,10-130 mL),2 days(range,1-3 days),respectively.Of 57 patients,4 had postoperative incision infection,3 had pulmonary infection,1 had adhesive intestinal obstruction,and they were cured after conservative treatment.Duration of postoperative hospital stay of 57 patients were 7 days(range,5-17 days).(2)Postoperative histopathological examination:of 57 patients,the number of lymph nodes dissected and length of surgical specimen were 21(range,13-27)and 30 cm(range,25-50 cm).All 57 patients h

关 键 词：结肠肿瘤 结肠切除术 手术入路 手术分离 腹腔镜检查 

分 类 号：R735.35[医药卫生—肿瘤]