结直肠癌联合多脏器及重要血管切除重建手术的疗效及安全性分析  

Efficacy and safety analysis of combined resection and reconstruction of multi-or⁃gan and vital vascular in colorectal cancer surgery

作　　者：王沈凡 吴震杰 施挺 武宇轩 冯翔 Wang Shenfan;Wu Zhenjie;Shi Ting;Wu Yuxuan;Feng Xiang(Department of Urology,First Affiliated Hospital of Naval Medical University(Shanghai Changhai Hospital),Shanghai 200433,China;Unit 91395 of the People’s Liberation Army,Beijing 102400,China)

机构地区：[1]海军军医大学第一附属医院(上海长海医院)泌尿外科,上海200433 [2]中国人民解放军91395部队,北京102400

出　　处：《结直肠肛门外科》2023年第4期346-350,共5页Journal of Colorectal & Anal Surgery

基　　金：国家自然科学基金面上项目(82072825,81874093);上海市青年医学人才“医苑新星”项目(2019YYXXWZJ);上海长海医院“优博计划”项目(2022-WZJ)。

摘　　要：目的 探讨结直肠癌联合多脏器及重要血管切除重建手术的疗效及安全性。方法 回顾性分析2018年1月至2022年1月海军军医大学第一附属医院(上海长海医院)泌尿外科收治的22例累及多脏器、重要血管的结直肠癌患者的临床资料。分析患者的一般情况(性别、年龄、肿瘤最大径、肿瘤病灶数目、原发/复发)、手术相关情况(ASA分级、整体血管切除重建情况、联合脏器切除情况、手术时间、术中出血量、术后住院时间)、术后并发症情况、围手术期死亡情况、术后随访情况。结果 22例患者中,男性10例、女性12例,原发肿瘤5例、复发肿瘤17例,平均年龄(59.3±9.2)岁,肿瘤平均最大径(6.5±3.1)cm,单个病灶18例(81.8%)、多个病灶4例(18.2%)。ASA分级Ⅰ级5例、Ⅱ级15例、Ⅲ级2例。21例患者肿瘤达到R0切除,1例R1切除。整体血管切除重建情况:腹主动脉部分切除人工血管重建1例,下腔静脉部分切除人工血管重建3例,腹主动脉及下腔静脉部分切除人工血管重建1例,下腔静脉部分切除结扎4例,下腔静脉部分切除结扎+左肾静脉人工血管重建1例,左肾静脉结扎1例,右肾静脉人工血管重建1例,左侧髂血管切除+人工血管股动脉—股动脉交叉转流术1例,右侧髂外动脉切除+右侧髂内—髂外动脉搭桥1例,右侧髂外静脉切除人工血管重建5例,左侧髂外静脉切除人工血管重建3例。12例患者联合脏器切除。平均手术时间(150±70) min,中位术中出血量600 (400,900) m L,中位术后住院时间6 (5,7) d。3例患者出现并发症,其中Cla-vien-Dindo分级Ⅱ级2例、Ⅲb级1例。中位随访时间为30 (15,45)个月,无失访患者。随访期间4例患者出现局部复发,6例患者出现远隔转移,5例患者死亡。结论 联合多脏器及重要血管切除重建的结直肠癌手术的R0切除率较高,术后并发症可控,总体安全可行。Objectives To investigate the efficacy and safety of combined resection and reconstruction of multi-organ and vital vascular in colorectal cancer surgery.Methods We retrospective analyzed data from 22 patients with colorectal cancer involving multiple organs and important blood vessels.These patients were admitted to the Department of Urology,First Affiliated Hospital of Naval Medical University(Shanghai Changhai Hospital)from January 2018 to January 2022.The patients’demographics(gender,age,maximum diameter of the tumor,number of tumor lesions,primary tumor/recurrence tumor),surgical details(ASA classifica⁃tion,en bloc vascular resection and reconstruction,combined organ resection,operation time,intraoperative blood loss,postopera⁃tive hospital stay),postoperative complications,perioperative death,and postoperative follow-up results were examined.Results Of the 22 patients,10 were male and 12 were female.5 were primary tumors while 17 were recurrence tumors,with an average age of(59.3±9.2)years old.The average maximum diameter of the tumor was(6.5±3.1)cm.There were 18 cases(81.8%)with single lesions and 4 cases(18.2%)with multiple lesions.According to ASA classification:5 were gradeⅠ,15 were gradeⅡ,and 2 were gradeⅢ.R0 resection was achieved in 21 cases and R1 resection in 1 case.En bloc vascular resection and reconstruc⁃tion:1 aortic partial resection and artificial blood vessel reconstruction,3 inferior vena cava partial resection and artificial blood vessel reconstruction,1 aortic and inferior vena cava partial resection and artificial blood vessel reconstruction,4 inferior vena ca⁃va partial resection and ligation,1 inferior vena cava partial resection and ligation+left renal vein artificial blood vessel recon⁃struction,1 left renal vein ligation,1 renal vein artificial blood vessel reconstruction,1 left iliac artery resection+artificial blood vessel femoral artery-femoral artery crossover bypass,1 right external iliac artery resection+right internal iliac artery-exter⁃nal iliac artery

关 键 词：结直肠癌 多脏器联合切除 血管切除重建 疗效 安全性 

分 类 号：R735.3[医药卫生—肿瘤]