改良尾侧入路腹腔镜右半结肠癌根治术临床应用探讨  

Clinical Application of Modified Posterior Approach for Laparoscopic Radical Resection of Right-Sided Colon Cancer

作　　者：王西杰 刘洪庆 李红军 WANG Xijie;LIU Hongqing(General Surgery Department,Second People's Hospital of Yinan County,Yinan,Shandong 276300,China;Surgical Department,Damatou Central Health Center,Guangrao County,Guangrao,Shandong 257337,China)

机构地区：[1]沂南县第二人民医院普外科,山东沂南276300 [2]广饶县大码头中心卫生院外科,山东广饶257337 [3]不详

出　　处：《社区医学杂志》2024年第12期422-428,共7页Journal Of Community Medicine

摘　　要：目的探讨分析改良尾侧入路腹腔镜下右半结肠癌根治术术中要点和难点,右半结肠癌根治术的淋巴清除范围。方法回顾性分析2015-04-01-2022-04-01沂南县第二人民医院124例腹腔镜右半结肠癌根治术患者的围手术期临床资料,其中改良尾侧入路46例(改良尾侧入路组),传统中间入路78例(传统入路组)。通过对比2组患者的一般资料,术中和术后资料及术后病理资料,分析改良尾侧入路右半结肠全结肠系膜切除术(CME)联合D_(3)淋巴结清除根治术,其手术安全性、术后恢复情况及肿瘤根治性。结果2组患者无严重并发症和死亡病例。改良尾侧入路组的手术时间[140(135.00,140.00)min]短于传统入路组[195.0(185.00,205.00)min],差异有统计学意义,P<0.01。改良尾侧入路组术中出血量[35.0(35.00,40.00)mL]少于传统入路组[85.0(80.00,90.00)mL],差异有统计学意义,P<0.01。改良尾侧入路组获取总淋巴结数(18.41±1.25)枚多于传统入路组(17.31±1.49)枚,差异有统计学意义,P<0.01。改良尾侧入路组获取阳性淋巴结数[0.50(0,3.60)枚]多于传统入路组[0(0,1.00)枚],差异无统计学意义,P>0.05。术中和术后病理及预后指标,改良尾侧入路组中转开腹(2.21%)与传统入路组中转开腹(7.60%)比较,差异无统计学意义,P>0.05。术后2组在首次排气时间、进食流质时间、总住院时间和术后住院时间、术后并发症发生率比较,差异无统计学意义,均P>0.05。结论腹腔镜下改良尾侧入路右半结肠CME联合D_(3)淋巴结清除根治术,手术时间短。术中出血少,可获得较多数目的总淋巴结,符合肿瘤根治原则。Objective To explore and analyze the key points and difficulties of the modified posterior approach for laparoscopic radical resection of right-sided colon cancer,as well as the scope of lymphatic clearance during the procedure.Methods A retrospective analysis was conducted on the perioperative clinical data of 124 patients who underwent laparoscopic radical resection of right-sided colon cancer at the Second People's Hospital of Yinan County from April 1,2015,to April 1,2022.Among them,46 cases underwent the modified posterior approach(modified posterior approach group),and 78 cases underwent the traditional median approach(traditional approach group).By comparing the general information,intraoperative and postoperative data,and postoperative pathological data of the two groups,this study analyzed the surgical safety,postoperative recovery,and tumor radicality of the modified caudal approach for right hemicolectomy with complete mesocolic excision(CME)combined with D_3 lymphadenectomy.Results No severe complications or deaths occurred in either group.The operation time of the modified posterior approach group[140(135.0,140.0)min]was shorter than that of the traditional approach group[195.0(185.0,205.0)min],with a statistically significant difference(P<0.01).The intraoperative blood loss in the modified posterior approach group[35.0(35.0,40.0)mL]was less than that in the traditional approach group[85.0(80.0,90.0)mL],with a statistically significant difference(P<0.01).The total number of lymph nodes retrieved in the modified posterior approach group(18.41±1.25)was higher than that in the traditional approach group(17.31±1.49),with a statistically significant difference(P<0.01).The number of positive lymph nodes obtained in the modified posterior approach group[0.50(0,3.60)]was higher than that in the traditional approach group[0(0,1.00)],but the difference was not statistically significant(P>0.05).Intraoperative and postoperative pathological and prognostic indicators showed that there was no statistically signi

关 键 词：改良尾侧入路联合中间入路 右半结肠癌根治术 原始后腹膜 胃结肠干 幽门下组淋巴结 大网膜 

分 类 号：R735.3[医药卫生—肿瘤]