结肠肝曲癌腹腔镜扩大右半结肠癌D3根治术中行幽门下组淋巴结清扫的临床资料分析  

Infrapyloric lymph node dissection for colon cancer of hepatic flexure in laparoscopic extended right hemicolectomy with D_(3) lymph node dissection of right colon cancer

作　　者：易小江 冯晓创 李洪明 廖伟林 卢新泉 汪佳豪 林佳鑫 刁德昌 Yi Xiaojiang;Feng Xiaochuang;Li Hongming;Liao Weilin;Lu Xinquan;Wang Jiahao;Lin Jiaxin;Diao Dechang(Department of Colorectal Surgery,Guangdong Provincial Hospital of Traditional Chinese Medicine/The Second Affiliated Hospital of Guangzhou University of Traditional Chinese Medicine,Guangzhou 510000,Guangdong,China)

机构地区：[1]广东省中医院(广州中医药大学第二附属医院)结直肠外科,广东广州510000

出　　处：《结直肠肛门外科》2022年第3期280-284,共5页Journal of Colorectal & Anal Surgery

摘　　要：目的总结腹腔镜扩大右半结肠癌D_(3)根治术中行幽门下组淋巴结清扫的结肠肝曲癌患者临床资料,以期为临床诊疗提供参考。方法回顾性分析2015年6月至2018年11月本科室收治的129例结肠肝曲癌患者的临床资料,患者均在腹腔镜扩大右半结肠癌D3根治术中行幽门下组淋巴结清扫。为了更好地显示幽门下组淋巴结转移情况,我们在后期对其中8例患者于术前使用纳米碳示踪技术。观察记录患者术中情况、淋巴结检出情况、术后并发症情况,以及术后恢复情况。结果129例患者中,1例因先天肠管旋转不良致腹腔严重粘连而中转开腹手术治疗,3例行联合脏器切除,6例术中输血,中位手术时间为165(150,190)min,中位术中出血量为16(15,16)mL;6例发生术后并发症,4例术后入住ICU,中位术后首次肛门排气时间为3(2,3)d,中位术后恢复进食时间为3(2,4)d,中位术后住院时间为7(6,9)d;中位淋巴结获取数目为19(18,19)枚,中位阳性淋巴结获取数目为2(2,3)枚,共获取幽门下组淋巴结710枚,中位幽门下组淋巴结获取数目为6(5,6)枚,幽门下组淋巴结阳性率为1.7%,中位阳性幽门下组淋巴结获取数目为0(0,0)枚。应用纳米碳示踪技术的8例患者均可见黑染幽门下组淋巴结,共获取幽门下组淋巴结27枚,平均幽门下组淋巴结获取数目为(3.4±1.1)枚,幽门下组淋巴结阳性率为18.5%,中位阳性幽门下组淋巴结获取数目为0(0,1.5)枚。结论对于结肠肝曲癌患者,幽门下组淋巴结转移是肿瘤转移路径之一,在腹腔镜扩大右半结肠癌D_(3)根治术中行幽门下组淋巴结清扫总体上是安全可行的。Objectives To summerize the clinical data of patients with colon cancer of hepatic flexure underwent infrapyloric lymph node dissection in laparoscopic extended right hemicolectomy with D3 lymph node dissection of right colon cancer,aiming to provide reference for clinical diagnosis and treatment.Methods This was a retrospective analysis of 129 patients with colon cancer of hepatic flexure treated at our department between June 2015 and November 2018.All patients underwent infrapyloric lymph node dissection in laparoscopic extended right hemicolectomy with D3 lymph node dissection of right colon cancer.In order to investigate the infrapyloric lymph node metastasis,carbon nanoparticle-labeled lymph node staining was performed in eight patients.Surgical details,lymph node yield,postoperative complications,and postoperative recovery were recorded.Results Of the 129 patients,one patient was converted to open surgery due to severe abdominal adhesion caused by congenital intestinal malrotation.Three patients had concomitant organ resection,and six patients had intraoperative infusion.The median duration of surgery was 165(150,190)min.The median intraoperative blood loss was 16(15,16)mL.Six patients experienced postoperative complications.Four patients were admitted to intensive care unit after the surgery.The median time to postoperative flatulence was 3(2,3)days,the median time to resumption of food intake was 3(2,4)days,and the median duration of postoperative hospitalization was 7(6,9)days.The median lymph node yield was 19(18,19),and the median positive lymph nodes yield was 2(2,3).A total of 710 infrapyloric lymph nodes were retrieved,and the median infrapyloric lymph node yield was 6(5,6).The positive rate of infrapyloric lymph node was 1.7%,and the median positive infrapyloric lymph node yield was 0(0,0).All eight patients who underwent carbon nanoparticle-labeled lymph node staining showed black-stained infrapyloric lymph node(s).Among these eight patients,a total of 27 infrapyloric lymph nodes was retrieved wi

关 键 词：结肠肝曲癌 扩大右半结肠癌D3根治术 幽门下组淋巴结 

分 类 号：R735.35[医药卫生—肿瘤]