经阴道取标本的完全腹腔镜右半/扩大右半结肠切除术治疗右半结肠癌25例临床资料分析  

Transvaginal extraction of the specimen after total laparoscopic right hemicolectomy or extended right hemicolectomy for right colon cancer:an analysis of 25 cases

作　　者：邓建中[1] 张梓朗 林义办[1] 郭校锡[1] 李朝阳[1] 王维春 余思 Deng Jianzhong;Zhang Zilang;Lin Yiban;Guo Xiaoxi;Li Zhaoyang;Wang Weichun;Yu Si(Department of Colorectal and Anal Surgery,The First People’s Hospital of Foshan,Foshan 528000,Guangdong,China;Department of Gastrointestinal Surgery,The Second People’s Hospital of Foshan,Foshan 528000,Guangdong,China)

机构地区：[1]佛山市第一人民医院肛肠外科,广东佛山528000 [2]佛山市第二人民医院胃肠外科,广东佛山528000

出　　处：《结直肠肛门外科》2022年第2期158-162,共5页Journal of Colorectal & Anal Surgery

摘　　要：目的探讨经阴道取标本的完全腹腔镜右半/扩大右半结肠切除术治疗右半结肠癌的临床疗效。方法回顾性分析2017年1月至2021年1月于佛山市第一人民医院行经阴道取标本的完全腹腔镜右半/扩大右半结肠切除术的25例右半结肠癌患者的临床资料。分析手术相关指标,术后镇痛药物使用情况及术后24 h疼痛程度(VAS评分),术后并发症发生情况,术后病理分期、辅助治疗情况,术后性功能情况及术后转移、复发情况。结果25例患者均顺利完成手术,其中8例为扩大右半结肠切除术。无中转开腹手术或改经腹取标本患者。无围术期死亡患者。平均手术时间为(203.3±26.9)min,平均术中出血量为(68.4±26.3)mL,平均切除肠管长度为(36.4±4.5)cm,平均标本环周直径为(5.4±1.6)cm,平均淋巴结检出数目为(25.4±5.3)枚。患者术后常规使用舒芬太尼自控静脉泵镇痛48 h,均未再使用其他镇痛药物,术后24 h平均VAS疼痛评分为(3.2±0.9)分,术后第1天均可下床活动。平均术后首次肛门排气时间为(3.3±0.9)d,平均术后住院时间为(8.2±1.8)d。3例患者出现术后并发症,包括2例肠梗阻、1例尿路感染。术后3个月内,无腹腔出血、盆腔感染、吻合口漏、吻合口狭窄等并发症。随访期内未出现吻合口漏、吻合口狭窄等并发症,也未出现与阴道切开相关的并发症。术后TNM分期:Ⅰ期5例,Ⅱ期11例,Ⅲ期9例。9例患者术后常规进行XELOX方案(卡培他滨联合奥沙利铂)化疗。术前有规律性生活的8例患者于术后3~6个月均逐渐恢复性生活,术前、术后7个月、术后12个月这三个时间点的女性性功能指数调查量表(FSFI)总评分比较差异有统计学意义(P<0.05),术后7个月、术后12个月的总评分均高于术前总评分,术后12个月的总评分高于术后7个月的总评分。术后中位随访时间为26个月,无失访病例,均未发现肿瘤转移或复发。结论经阴道取标本的�Objectives To determine the clinical effectiveness of transvaginal extraction of the specimen after total laparoscopic right hemicolectomy or extended right hemicolectomy for right colon cancer.Methods This was a retrospective analysis of 25patients with right colon caner treated with transvaginal extraction of the specimen after total laparoscopic right hemicolectomy or extended right hemicolectomy at the First People’s Hospital of Foshan between January 2017 and January 2021.Surgical parameters,postoperative analgesic,pain at 24 hours after surgery(using Visual Analogue Scale),postoperative complications,pathological staging,adjuvant therapy,postoperative sexual function,postoperative metastasis,and recurrence were analyzed.Results All surgeries were uneventful.Eight patients had extended right hemicolectomy.There were no conversions to open surgery or transabdominal extraction of the specimen.There was no death during the perioperative period.The mean(SD)duration of surgery was 203.3(26.9)min.The mean(SD)intraoperative blood loss was 68.4(26.3)mL.The mean(SD)resected intestine’s length was36.4(4.5)cm.The mean(SD)specimen’s circumferential diameter is 5.4(1.6)cm.The mean(SD)lymph node yield was 25.4(5.3).Patients received sufentanil for intravenous patient-controlled analgesia for 48 hours with no other analgesics.The mean(SD)pain score was 3.2(0.9)at 24 hours after surgery.All patients started off-bed activities 1 day after surgery.The mean(SD)time to postoperative flatulence was 3.3(0.9)days.The mean(SD)postoperative hospitalization duration was 8.2(1.8)days.Three patients had postoperative complications,including two having intestinal obstruction and one having urinary tract infection.There were no complications such as abdominal bleeding,pelvic infection,anastomotic leakage,and stoma stricture within 3 months after surgery.During the follow-up,there were no complications such as anastomotic leakage,stoma stricture,or complications related to vaginal incision.Five patients were stageⅠ,11 were stage�

关 键 词：右半结肠癌 完全腹腔镜右半结肠切除术 经自然腔道取标本手术 经阴道取标本手术 

分 类 号：R735.35[医药卫生—肿瘤]