经末段回肠系膜后隧道完成重叠式三角吻合的结肠脾曲癌完全腹腔镜左半结肠切除术23例临床分析  

Totally laparoscopic left hemicolectomy with overlapping delta-shaped anastomosis through the tunnel of terminal ileal mesentery:an analysis of 23 cases with splenic flexure cancer

作　　者：徐正 苏昊 包满都拉 罗寿 张岳阳 关旭 张明光 赵志勋 梁建伟 刘正 刘骞 王锡山 周海涛 Zheng Xu;Hao Su;Mandula Bao;Shou Luo;Yueyang Zhang;Xu Guan;Mingguang Zhang;Zhixun Zhao;Jianwei Liang;Zheng Liu;Qian Liu;Xishan Wang;Haitao Zhou(Department of Colorectal Surgery,National Cancer Center,National Clinical Research Center for Cancer/Cancer Hospital,Chinese Academy of Medical Science and Peking Union Medical College,Beijing 100021,China;Department of Gastrointestinal Surgery,Key Laboratory of Carcinogenesis and Translational Research(Ministry of Education/Beijing),Peking University Cancer Hospital&Institute,Beijing 100142,China;Department of Pancreatic and Gastric Surgery,National Cancer Center,National Clinical Research Center for Cancer/Cancer Hospital,Chinese Academy of Medical Science and Peking Union Medical College,Beijing 100021,China;Department of Gastrointestinal Surgery,National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital&Shenzhen Hospital,Chinese Academy of Medical Sciences and Peking Union Medical College,Shenzhen 518116,China)

机构地区：[1]国家癌症中心/国家肿瘤临床医学研究中心/中国医学科学院北京协和医学院肿瘤医院结直肠外科,北京100021 [2]北京大学肿瘤医院暨北京市肿瘤防治研究所,恶性肿瘤发病机制及转化研究教育部重点实验室胃肠肿瘤中心,100142 [3]国家癌症中心/国家肿瘤临床医学研究中心/中国医学科学院北京协和医学院肿瘤医院胰胃外科,北京100021 [4]国家癌症中心/国家肿瘤临床医学研究中心/中国医学科学院北京协和医学院肿瘤医院深圳医院胃肠外科,518116

出　　处：《中华结直肠疾病电子杂志》2023年第3期253-259,共7页Chinese Journal of Colorectal Diseases(Electronic Edition)

基　　金：国家卫生健康委员会医药卫生科技发展研究中心2021年微创手术临床应用规范研究课题(WA2021RW13);中国医学科学院医学与健康科技创新工程(重大协调创新项目)(2021-I2M-1-010)。

摘　　要：目的探讨采用经末段回肠系膜后隧道完成重叠式三角吻合的完全腹腔镜左半结肠切除术在结肠脾曲癌外科治疗中的可行性、安全性及近期疗效。方法回顾性收集中国医学科学院北京协和医学院肿瘤医院2018年1月至2022年1月收治的结肠脾曲癌患者中,行经末段回肠系膜后隧道完成重叠式三角吻合的完全腹腔镜左半结肠切除手术的23例患者临床和病理资料,统计并分析患者基线资料、手术情况、术后病理情况、术后恢复及围手术期并发症等数据。结果23例患者均成功施行经末段回肠系膜后隧道完成腔内吻合的完全腹腔镜左半结肠切除术。中位手术时间165 min,中位术中出血量为40 mL,中位切口长度为5.0 cm。手术标本肿瘤中位长径为4.3 cm,中位近端切缘为13.2 cm,中位远端切缘为12.1 cm,中位淋巴结检出数目为19枚。患者中位术后下地时间、进食时间、排气时间、排便时间与住院时间分别为17.5 h、12 h、33.5 h、55.5 h、5 d。随访30天内,1例患者出现腹腔感染,经抗感染保守治疗后好转。其余患者未出现切口感染、吻合口漏、腹腔出血、肠梗阻等并发症。结论经末段回肠系膜后隧道行完全腹腔镜下重叠式三角吻合可应用于结肠脾曲癌患者的外科治疗,安全可行,近期疗效满意,远期疗效待进一步随访观察。Objective To explore the short-term outcomes of totally laparoscopic left hemicolectomy with overlapping delta-shaped anastomosis through the tunnel of terminal ileal mesentery in the surgical treatment of splenic flexure cancer.Methods We retrospectively collected the 23 patients diagnosed with splenic flexure cancer who underwent the totally laparoscopic left hemicolectomy with overlapping delta-shaped anastomosis through the tunnel of terminal ileal mesentery in National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital from January 2018 to January 2022.Baseline variables,surgical outcomes,pathological characteristics,postoperative recovery and complications were analyzed.Results All patients have successfully undergone the totally laparoscopic left hemicolectomy with overlapping delta-shaped anastomosis through the tunnel of terminal ileal mesentery.The median operation time was 165 min.The median estimated blood loss was 40 mL and the median incisional length was 5.0 cm.With regard to pathological characteristics,the median length of tumor was 4.3 cm.The median proximal and distal resection margin was 13.2 cm and 12.1 cm,respectively.The median time to first ground activities,first oral intake,first flatus passage,first defecation,and postoperative hospital stay were 17.5 h,12 h,33.5 h,55.5 h,5 d,respectively.One patient suffered from the abdominal infection,which was controlled after antibiotic therapy.Other patients were not suffered from incisional infection,anastomotic leakage,abdominal bleeding or intestinal obstruction during the 30-day follow-up period.Conclusion Totally laparoscopic left hemicolectomy with overlapping delta-shaped anastomosis through the tunnel of terminal ileal mesentery could be applied in the surgical treatment of splenic flexure cancer with satisfactory short-term outcomes.But the long-term outcomes need to be explored.

关 键 词：结肠肿瘤 腹腔镜 脾曲肿瘤 末段回肠系膜后隧道 左半结肠切除 重叠式三角吻合 

分 类 号：R735.35[医药卫生—肿瘤]