头侧优先逆时针顺序全结肠系膜切除在腹腔镜右半结肠切除术的应用  

Cranial approach priority,counterclockwise sequential comple mesocolic excision in laparoscopic right hemicolectomy

作　　者：姚增武 王熙勋[1] 张翼飞[1] 胡金晨 鉴谧 刘传绪 于彬 崔洪铭 赵扬 姜立新[1,3] Yao Zengwu;Wang Xixun;Zhang Yifei;Hu Jinchen;Jian Mi;Liu Chuanxu;Yu Bin;Cui Hongming;Zhao Yang;Jiang Lixin(Department of Gastrointestinal Surgery,Yantai Yuhuangding Hospital,Yantai 264000,China;Shandong University,Jinan 250100,China;General Surgery,Development District Branch of Yantai Yuhuangding Hospital(Yantai Yeda Hospital),Yantai 264000,China)

机构地区：[1]烟台毓璜顶医院胃肠外一科,烟台264000 [2]山东大学,济南250100 [3]烟台毓璜顶医院开发区分院(烟台业达医院)普外科,烟台264000

出　　处：《中华内分泌外科杂志》2022年第6期645-649,共5页Chinese Journal of Endocrine Surgery

基　　金：山东大学项目(3460019005);烟台市科技发展计划(2019MSGY136);烟台毓璜顶医院青年科研启动基金(201813)。

摘　　要：目的分析头侧优先,逆时针全结肠系膜切除在腹腔镜根治性右半结肠切除术中的有效性和安全性。方法回顾性分析2020年1月至2020年12月烟台毓璜顶医院胃肠外一科收治的右半结肠癌患者30例,均采用头侧优先,进而尾侧,最后中间入路,逆时针顺序全结肠系膜切除的入路进行腹腔镜根治性右半结肠切除术。记录患者的一般临床病理学资料,围手术期资料如手术时间、术中出血量、Henle干及属支损伤出血例数,是否中转开腹、术后病理学资料(TNM分期,总清扫淋巴结数目及转移性淋巴结数目)、术后恢复(术后排气时间、进食流质、拔除引流管及住院时间)以及并发症(如出血、吻合口瘘、二次手术、淋巴漏、肺部感染、腹腔感染、切口感染等)。术后1年采用电话或门诊随访等方法进行随访。结果总手术时间(197.80±31.20)min,范围150~275min,术中出血量(58.33±30.30)ml,范围10~100 ml。无术中Henle干属支损伤出血及中转开腹病例。术后排气时间(2.97±0.67)d,范围2~4d;术后进食流质时间(3.67±0.76)d,范围3~5 d;术后拔除引流管时间(6.60±4.00)d,范围4~25 d;术后住院时间为(7.87±3.94)d,范围5~26 d。pTNM分期:Ⅰ期9例、ⅡA期5例、ⅡB期1例、ⅢA期6例、ⅢB期4例、ⅢC期5例。清扫总淋巴结数目(29.50±8.18)枚,范围19~51枚;转移淋巴结数目(1.40±1.77)枚,范围0~6枚。术后并发症:切口感染1例,淋巴漏2例,肺部感染1例,吻合口瘘1例,经过保守治疗均治愈出院。随访期间未发现肿瘤复发或转移,无一例患者死亡。结论头侧优先,逆时针顺序全结肠系膜切除在腹腔镜根治性右半结肠切除术安全有效。Objective To analyze the efficacy and safety of cranial approach priority,counterclockwise sequential comple mesocolic excision in laparoscopic right hemicolectomy.Methods From Jan.2020 to Dec.2020,30 patients with right colon cancer in Department of Gastrointestinal Surgery were retrospectively analyzed.Laparoscopic radical right hemicolectomy was performed via the approach of complete mesocolic excision.The general clinicopathological data of the patients,perioperative data such as operation time,intraoperative blood loss,number of cases of hemorrhage caused by Henle trunk and subordinate branch injury,whether or not converted to open surgery,postoperative pathological data(TNM staging,total number of dissected lymph nodes and the number of metastatic lymph nodes),postoperative recovery(exhaust time,the time of fluid intake,drainage tube removal and hospital stay),and complications(such as bleeding,anastomotic leakage,secondary surgery,lymphatic leakage,pulmonary infection,abdominal infection,incision infection,etc)were recorded.Follow-up was performed by telephone or outpatient in 1 year after surgery.Results The total operation time was(197.80±31.20)minutes,ranging from 150 to 275 minutes,and the intraoperative blood loss was(58.33±30.30)ml,ranging from 10 to 100 ml.There were no cases of intraoperative Henle stem and branch injury bleeding or conversion to open surgery.Postoperative exhaust time was(2.97±0.67)d,ranging from 2 to 4d;postoperative fluid intake time was(3.67±0.76)d,ranging from 3 to 5d;postoperative drainage tube removal time was(6.60±4.00)d,ranging from 4 to 25 days;postoperative hospital stay was(7.87±3.94)days,ranging from 5 to 26 days.pTNM staging:9 cases of stage I,5 cases of stage IIA,1 case of stage IIB,6 cases of stage IIIA,4 cases of stage IIIB,and 5 cases of stage IIIC.The total number of lymph nodes dissected was(29.50±8.18),ranging from 19 to 51;the number of metastatic lymph nodes was(1.40±1.77),ranging from 0 to 6.Postoperative complications included incision infection in

关 键 词：结肠癌 头侧优先 逆时针 全结肠系膜切除术 腹腔镜右半结肠切除术 

分 类 号：R735.35[医药卫生—肿瘤]