摘要
目的探讨有限中间入路腹腔镜右半结肠癌根治术的临床疗效。方法采用回顾性描述性研究方法。收集2016年7月至2018年4月天津医科大学肿瘤医院收治的32例右半结肠癌患者的临床资料;男15例,女17例;平均年龄为62岁;年龄范围为49~70岁。手术遵循不接触隔离原则,采用头侧-尾侧-中间入路顺序行腹腔镜右半结肠癌根治术。观察指标:(1)手术和术后恢复情况。(2)术后病理学检查情况。(3)随访情况。采用门诊及电话方式进行随访,了解患者术后生存及肿瘤复发、转移情况。随访时间截至2018年5月。计量资料以平均值(范围)表示。结果(1)手术和术后恢复情况:32例患者均顺利完成有限中间入路腹腔镜右半结肠癌根治术,无中转开腹和围术期死亡。32例患者手术时间为180min(150~260min),术中出血量为100mL(50~350mL);术后首次肛门排气时间为3d(2~6d),术后开始进食流质食物时间为4d(3~7d)。32例患者中,3例发生术后并发症,其中肠梗阻、切口感染和腹泻各1例,均经对症处理后好转。患者术后住院时间为12d(10~22d)。(2)术后病理学检查情况:32例患者淋巴结清扫数目为28枚(19~43枚),中央淋巴结清扫数目为8枚(6~12枚)。手术切除标本长度为30cm(25~39cm),切缘均为阴性。病理学T分期:pT1期2例,pT2期8例,pT3期19例,pT4a期3例;病理学N分期:pN0期16例,pN1期12例,pN2期4例。病理学类型:黏液腺癌3例,高分化腺癌7例,中分化腺癌18例,低分化腺癌4例。(3)随访情况:32例患者均获得术后随访,随访时间范围为1~22个月,平均随访时间为11个月。随访期间,6例患者肿瘤远处转移,其余26例患者均无瘤生存。结论有限中间入路腹腔镜右半结肠癌根治术安全可行,近期疗效满意。
ObjectiveTo investigate the clinical efficacy of laparoscopic right hemicolectomy via limited medial approach. MethodsThe retrospective and descriptive study was conducted. The clinical data of 32 patients [15 males and 17 females,average age 62 years (range,49-70 years] with right colon cancer who were admitted to the Tianjin Medical University Cancer Hospital between July 2016 and April 2018 were collected. All the patients underwent laparoscopic right hemicolectomy via cranial-caudal-medial approach followed no-touch isolation technique.Observation indicators:(1) surgical and postoperative recovery situations;(2) postoperative pathological examination;(3) follow-up situations.Follow-up using outpatient examination and telephone interview to detect postoperative survival of patients and tumor metastasis or recurrence up to May 2018.Measurement data were represented as average (range).Results(1) Surgical and postoperative recovery situations:32 patients underwent successfully laparoscopic right hemicolectomy via limited medial approach,without conversion to open surgery and perioperative death.The operation time,volume of intraoperative blood loss,time to initial anal exsufflation, time for fluid diet intake and duration of postoperative hospital stay were 180 minutes (range, 150-260 minutes),100 mL (range, 50-350 mL),3 days (range,2-6 days),4 days (range, 3-7 days) and 12 days (range,10-22 days), respectively. Of 3 with postoperative complications in the 32 patients,1 with paralytic ileus,1 with wound infection and 1 with diarrhea were improved by symptomatic treatment.(2) Postoperative pathological examination:the number of dissected lymph nodes,number of dissected central lymph nodes and length of surgical specimen were 28 (range,19-43),8 (range,6-12) and 30 cm (range,25-39 cm),respectively, with negative incision margins. Postoperative tumor pathological staging showed that stage pT1,pT2,pT3 and pT4a were detected in 2,8,19 and 3 patients, and stage pN0, pN1 and pN2 in 16,12 and 4 patients, respectively.Postoperative tumor pathological typing showed that 3,7,18 and 4 patients were respectively diagnosed with mucinous adenocarcinoma,high differentiated adenocarcinoma,moderate differentiated adenocarcinoma and low differentiated adenocarcinoma.(3) Follow-up situations:32 patients were followed-up for 1-22 months,with an average time of 11 months.During the follow-up,6 patients were complicated with distant metastasis and the others had disease-free survival.ConclusionLaparoscopic right hemicolectomy via limited medial approach is safe and feasible,with a good short-term outcome.
作者
汤思哲
王仆
田斐
孔大陆
Tang Sizhe;Wang Pu;Tian Fei;Kong Dalu(Department of Colorectal Cancer,Tianjin Medical University Cancer Institute and Hospital,National Clinical Research Center for Cancer,Tianjin Key Laboratory of Cancer Prevention and Therapy,Tianjin's Clinical Research Center for Cancer,Tianjin 300060,China)
出处
《中华消化外科杂志》
CAS
CSCD
北大核心
2019年第1期91-95,共5页
Chinese Journal of Digestive Surgery
基金
国家自然科学基金(81372394).
关键词
结肠肿瘤
中间入路
头侧入路
尾侧入路
有限中间入路
根治术
腹腔镜检查
Colonic neoplasms
Medial approach
Cranial approach
Caudal approach
Limited medial approach
Radical resection
Laparoscopy
作者简介
通信作者:孔大陆,Email: kongdl@hotmail.com
