腹腔镜下右半结肠癌D3根治术中SMA或SMV入路的选择  

Selection of SMA or SMV approach during laparoscopic D3 radical resection of right colon cancer

作　　者：孙龙凤 侯高峰 王幼黎[1] 刘磊 Sun Longfeng;Hou Gaofeng;Wang Youli;Liu Lei(Department of General Surgery,Aviation General Hospital,Beijing 100012,China)

机构地区：[1]航空总医院普外科,北京100012

出　　处：《中华普外科手术学杂志（电子版）》2024年第4期438-441,共4页Chinese Journal of Operative Procedures of General Surgery(Electronic Edition)

摘　　要：目的探究腹腔镜下右半结肠癌D3根治术中肠系膜上动脉(SMA)或肠系膜上静脉(SMV)入路方式的选择问题。方法回顾性分析2019年1月至2022年5月80例右半结肠癌患者的临床资料,按照入路方式分为SMA组(采用肠系膜上动脉入路方式行腹腔镜下右半结肠癌D3根治术)和SMV组(采用肠系膜上静脉人路方式行腹腔镜下右半结肠癌D3根治术),每组患者各40例。采用SPSS26.0软件分析数据,围手术期相关指标等计量资料以(x±s)表示,采用独立样本t检验;术后并发症等计数资料采用X检验;生存分析采用Kaplan-Meier法并行Log-Rank检验。P<0.05为差异有统计学意义。结果相比SMV组,SMA组患者术中出血量明显减少,淋巴结清扫数量、术后引流量、引流管留置时间明显增加,差异均有统计学意义(P<0.05);两组患者术后并发症发生率比较差异无统计学意义(P>0.05);SMA组和SMV组患者术后1年总生存率(90.0%us.80.0%)和无进展生存率(85.0%us.72.5%)比较差异无统计学意义(Log-RankX=2.235、2.638,P=0.152、0.071)。结论腹腔镜下右半结肠癌D3根治术中,相比SMV入路方式,SMA入路增加了淋巴结清扫数量,减少了术中出血量,在后续诊疗中具有重要意义。Objective To explore the choice of superior mesenteric artery(SMA)or superior mesenteric vein(SMV)approach in laparoscopic D3 radical operation for right colon cancer.Methods The clinical data of 80 patients with right hemicolonic carcinoma from January 2019 to May 2022 were retrospectively analyzed and divided into SMA group(laparoscopic D3 radical resection of right hemicolonic carcinoma by superior mesenteric artery approach)and SMV group(laparoscopic D3 radical resection of right hemicolonic carcinoma by superior mesenteric vein approach)according to the approach method.There were 40 patients in each group.SPSS 26.O software was used to analyze the data.Measurement data such as perioperative indicators were expressed as(x±s),and independent sample t test was used.The postoperative complications were counted by X test.Kaplan-Meier method and Log-Rank test were used for survival analysis.P<0.05 was considered statistically significant.ResultsCompared with SMV group,the amount of intraoperative blood loss in SMA group was significantly reduced,and the number of lymph node dissection,postoperative drainage volume,and drainage tube retention time were significantly increased,with statistical significance(P<0.05).There was no significant difference in the incidence of postoperative complications between the two groups(P>0.05).There was no significant difference in 1-year overall survival(90.0%us.80.0%)and progression-free survival(85.0%vs.72.5%)between SMA and SMV groups(Log-Rank x^(2)=2.235,2.638,P=0.152,0.071).Conclusion Compared with the SMV approach,the SMA approach increased the number of lymph node dissection and reduced the amount of intraoperative blood loss during the D3 radical operation of the right half colon cancer under laparoscopy,which is of great significance in the follow-up diagnosis and treatment.

关 键 词：结肠肿瘤 腹腔镜 肠系膜上动脉 肠系膜上静脉 入路方式 

分 类 号：R735.35[医药卫生—肿瘤]