腹腔镜右半结肠癌根治术中保留胃网膜右静脉的临床研究  

Clinical study on preserving right gastroepiploic vein during laparoscopic right hemicolectomy

作　　者：尤小兰[1] 连彦军[1] 吴健[1] 王元杰[1] 戴佳文[1] 赵小军[1] 程之逸[1] 黄传江[1] 李文琦[2] 周艳[3] You Xiaolan;Lian Yanjun;Wu Jian;Wang Yuanjie;Dai Jiawen;Zhao Xiaojun;Cheng Zhiyi;Huang Chuanjiang;Li Wenqi;Zhou Yan(Department of Gastrointestinal Surgery,Taizhou People's Hospital,Taizhou,Jiangsu 225300,China;Department of Medical Quality and Safety Control,Taizhou People's Hospital,Taizhou,Jiangsu 225300,China;Department of Scientific Research and Teaching,Taizhou People's Hospital,Taizhou,Jiangsu 225300,China)

机构地区：[1]江苏省泰州市人民医院胃肠外科,225300 [2]江苏省泰州市人民医院医疗质量与安全控制科,225300 [3]江苏省泰州市人民医院科研教学科,225300

出　　处：《中华胃肠外科杂志》2020年第12期1164-1169,共6页Chinese Journal of Gastrointestinal Surgery

基　　金：中国博士后基金(2018M632400);泰州市科技支撑计划(社会发展)项目(TS201824、202012);泰州市第五期“311工程”培养对象科研资助项目(RCPY202022)。

摘　　要：目的腹腔镜右半结肠癌根治手术的入路及手术步骤已程序化并达成专业共识,然而,一些细节问题如手术中Henle干的处理、术中是否保留胃网膜右静脉(RGEV)等仍然存在争议。为此,本研究探讨腹腔镜右半结肠癌根治术中保留RGEV的安全性、可行性以及近、远期临床疗效。方法采用回顾性队列研究的方法,分析2016年3月至2018年5月期间,在江苏省泰州市人民医院胃肠外科接受腹腔镜右半结肠癌根治术的92例患者的临床资料。所有病例均行右半结肠完整结肠系膜切除术(CME),术后病理数据及随访资料完整。根据肿瘤具体位置决定术中是否保留RGEV,49例为保留RGEV组,43例为不保留RGEV组,分析比较两组患者术后一般情况、肿瘤安全性指标、术后并发症及近、远期疗效。结果保留RGEV组与不保留RGEV组患者基线资料的比较,差异无统计学意义(均P>0.05)。保留RGEV组与不保留RGEV组手术时间、术中出血量、非计划再手术、吻合口漏、清扫淋巴结数目、转移淋巴结数目、术后进食时间比较,差异均无统计学意义(均P>0.05)。与不保留RGEV组相比,保留RGEV组术后缩短了肛门排气时间[(3.1±1.0)d比(4.0±1.7)d,t=-2.787,P=0.007]和住院时间[(11.5±1.5)d比(15.0±7.9)d,t=-2.823,P=0.007];降低了住院费用[(4.6±0.5)万元比(5.7±3.3)万元,t=-2.076,P=0.044]。不保留RGEV组围手术期胃瘫发生率14.0%(6/43),保留RGEV组无胃瘫病例发生(P<0.05)。中位随访时间31.8(5.2~43.7)个月,保留RGEV组与不保留RGEV组总体生存期分别为(35.4±1.8)个月和(37.6±1.7)个月,差异无统计学意义(P=0.336);无病生存期分别为(32.0±2.2)个月和(35.5±2.0)个月,差异也无统计学意义(P=0.201)。结论腹腔镜右半结肠癌根治术中保留RGEV安全、可行,可降低术后胃瘫发生率,缩短术后肠功能恢复时间和住院时间,并减少住院费用。与不保留RGEV相比,疗效相当。Objective The operative approach and steps of laparoscopic right hemicolon cancer radical resection have been standardlized and professional consensus has been reached.However,some detailed issues such as the handling of Henle's trunk and whether to preserve the right gastroepiploic vein(RGEV)still remain controversial.This study investigates the safety,feasibility,short⁃and long⁃term outcomes of preserving RGEV during laparoscopic right hemicolectomy.Methods A retrospective cohort study was carried out.Clinical data of 92 patients undergoing laparoscopic right hemicolectomy in Taizhou People's Hospital from March 2016 to May 2018 were retrospectively analyzed.All the patients were treated with complete mesocolon resection(CME)and had complete postoperative pathological data and follow⁃up data.Based on the tumor location,49 patients preserved RGEV(preservation group)and 43 did not(non⁃preservation group).Pathological data,postoperative complications,short⁃and long⁃term outcomes were compared between the two groups.Results There were no significant differences in baseline data between the two groups(all P>0.05).No significant differences were found in operation time,intraoperative blood loss,unplanned reoperation,anastomotic leak,number of harvested lymph nodes,number of metastatic lymph node,and time to food intake after surgery between two groups(all P>0.05).Compared with non⁃preservation group,the preservation group had faster recovery of anal gas passage after operation[(3.1±1.0)days vs.(4.0±1.7)days,t=-2.787,P=0.007],shorter length of hospitalization[(11.5±1.5)days vs.(15.0±7.9)days,t=-2.823,P=0.007],and reduced the hospitalization expenses[(46000±5000)yuan to(57000±33000)yuan,t=-2.076,P=0.044].No postoperative gastroparesis(PGS)occurred in the preservation group,while 6 cases in the non⁃preservation group developed gastroparesis during perioperative period(P<0.05).The median time of follow⁃up time was 31.8(5.2⁃43.7)months.The overall survival time of the preservation group and non�

关 键 词：结肠肿瘤 右半结肠癌根治术 胃网膜右静脉 胃瘫 

分 类 号：R735.35[医药卫生—肿瘤]