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 significant difference in the rate of conversion to open surgery between the modified posterior approach group(2.21%)and the traditional approach group(7.60%)(P>0.05).There were no statistically significant differences between the two groups in terms of first exhaust time,time to resume liquid diet,total hospital stay,postoperative hospital stay,and postoperative complication rate(all P>0.05).Conclusion The laparoscopic modified posterior approach for right hemicolectomy with complete mesocolic excision(CME)combined with D_(3)lymph node dissection has a shorter operation time,less intraoperative bleeding,and can obtain a larger number of total lymph nodes,which is in line with the principles of tumor radical resection.
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)
出处
《社区医学杂志》
CAS
2024年第12期422-428,共7页
Journal Of Community Medicine
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
modified posterior approach combined with median approach
radical resection of right-sided colon cancer
primitive retroperitoneal space
gastrocolic trunk
infrapyloric lymph nodes
greater omentum
作者简介
第一作者:王西杰,男,山东临沂人,副主任医师,主要从事普通外科的研究工作。E-mail:ynxdermyywxj@163.com;通信作者:李红军,男,河北乐亭人,硕士,主任医师,主要从事化学物中毒及胃肠道肿瘤疾病相关的临床研究工作。E-mail:1169750660@qq.com。
