单孔加一腹腔镜技术在左半结肠癌中的应用探索  

Application of single-port plus one port laparoscopic technique in left hemi-colon cancer

作　　者：刘文居[1] 臧卫东[1] 滕文浩[1] 陈梅梅 LIU Wen-ju;ZANG Wei-dong;TENG Wen-hao(Department of Gastrointestinal Surgery,Clinical Oncology School of Fujian Medical University,Fujian Cancer Hospital,Fuzhou 350014,China)

机构地区：[1]福建医科大学肿瘤临床医学院、福建省肿瘤医院胃肠肿瘤外科,福建福州350014

出　　处：《腹腔镜外科杂志》2023年第1期50-54,共5页Journal of Laparoscopic Surgery

基　　金：福建省卫健委中青年骨干人才培养项目(2021GGA041)。

摘　　要：目的:探讨单孔加一腹腔镜左半结肠癌根治术的近期疗效。方法:回顾性收集2018年10月至2022年11月为39例患者行单孔加一腹腔镜左半结肠切除术的临床资料,详细记录围手术期指标及术后随访情况。结果:手术均顺利完成,无中转开腹或围手术期死亡病例,1例患者术中添加1个辅助操作孔。手术时间平均(165.9±40.7)min,出血量50(20,100)mL,肿瘤最大径(4.0±1.2)cm,肿瘤近切缘(6.0±2.9)cm,远切缘(11.0±4.7)cm,清扫淋巴结数量(24.4±11.9)枚,总切口长度(5.1±0.8)cm,首次下床活动时间(20.1±2.0)h,首次排气时间(65.4±3.6)h,首次排便时间(96.7±3.8)h,首次进食时间(3.0±1.0)d,术后前3天疼痛评分分别为(2.9±1.1)分、(2.3±0.5)分、(1.4±0.5)分,平均住院(9.2±2.5)d, 38例患者对切口美容效果评价非常满意,1例满意。术后5例发生并发症,发生率为12.8%。中位随访时间24(3~51)个月,6例出现远处转移,未出现局部复发病例。结论:采用单孔加一腹腔镜技术治疗左半结肠癌是安全、可行的,在美容效果及减轻术后切口疼痛方面具有潜在优势。Objective:To evaluate the short-term outcomes of single-incision plus one port laparoscopic radical resection for left colon cancer patients.Methods:The clinical data of 39 patients undergoing single-port plus one laparoscopic left hemicolectomy admitted from Oct.2018 to Nov.2022 were retrospectively collected, and the perioperative indicators and follow-up were recorded in detail.Results:All patients completed laparoscopic surgery, and there was no conversion to open surgery or perioperative death cases.Among them, one patient had an auxiliary operating port added intraoperatively.Mean operative time was(165.9±40.7)min, blood loss was 50(20,100)mL,maximum tumor diameter was(4.0±1.2)cm, proximal tumor margin was(6.0±2.9)cm, distal margin was(11.0±4.7)cm, the number of dissected lymph nodes was(24.4±11.9),total incision length was(5.1±0.8)cm, first ambulation time was(20.1±2.0)h, time to first bowel movement was(65.4±3.6)h, time to first defecation was(96.7±3.8)h, time to first food intake was(3.0±1.0)d, the mean pain scores for the 3 days after surgery were(2.9±1.1),(2.3±0.5) and(1.4±0.5) points, and the mean postoperative hospital stay was(9.2±2.5)d.Thirty-eight patients rated the cosmetic results as very satisfactory and one case as satisfactory.In addition, 5 patients developed postoperative complications, and the morbidity rate was 12.8%.During a median follow-up of 24(3-51) months, distant metastases were found in 6 patients, but there were no patients with local recurrence.Conclusions:The treatment of left hemi-colon cancer by single-port plus one port laparoscopic technique is safe and feasible, and has potential advantages in terms of mild pain and cosmetic results.

关 键 词：结肠肿瘤 结肠癌根治术 腹腔镜检查 单孔加一 

分 类 号：R735.3[医药卫生—肿瘤]