腹腔镜右半结肠癌完整系膜切除术经尾侧-中间联合入路回顾性研究

doi:10.16139/j.1007-9610.2020.03.008

摘要/Abstract

摘要：

目的:比较腹腔镜右半结肠癌完整系膜切除术（complete mesocolic excision, CME）经尾侧-中间联合入路（简称尾侧联合入路）与传统中间入路（简称中间入路）在手术学、肿瘤学等方面的效果。方法:回顾性分析2017年1月至6月收治的68例右半结肠癌病人。根据手术入路分为尾侧联合入路组37例及中间入路组31例。采用West分级系统评估比较两组的CME完成质量以及手术安全性、术后近期疗效及远期预后。结果:病人均经CME完成质量评估。尾侧联合入路组CME完成率为86.5%,中间入路组CME完成率为80.6%。两组间差异无统计学意义（P=0.53）。尾侧联合入路组腹腔镜下解剖时间较中间入路缩短[（62.70±12.22） min比（70.39±11.98） min,P=0.01]。两组病人总手术时间、术中出血量、术后排气时间、术后并发症发生及远期预后差异均无统计学意义。结论:腹腔镜右半结肠癌CME,经尾侧联合入路可缩短腹腔镜下解剖时间,CME完成质量、安全性、预后两种手术入路相当。

关键词: 结肠癌, 结肠完整系膜切除术, 腹腔镜右半结肠癌根治术, 尾侧-中间联合入路, 传统中间入路

Abstract:

Objective To investigate pathologic effects combined with postoperative results on right colon cancer with laparoscopic complete mesocolic excision(CME) via dorsal-medial hybrid approach compared with traditional medial approach. Methods A total of 68 patients with right colon cancer undergoing laparoscopic CME in our hospital between Ja-nuary and June 2017 were studied retrospectively. There were two groups including 37 cases in dorsal-medial hybrid group and 31 cases in traditional medial group. CME quality evaluated with the method proposed by West et al along with safety, short-term results and long-term prognosis were compared between two groups. Results CME completion rate was 86.5% in dorsal-medial hybrid group and 80.6% in traditional medial group without statistical difference(P=0.53). Laparoscopic dissection time in dorsal-medial group was significantly shorter than that in traditional medial group[(62.70±12.22) min vs.(70.39±11.98) min, P=0.01]. There was no statistical difference in operation time, blood loss, postoperative flatus time, postoperative complications and long-term prognosis of the patients between two groups. Conclusions Laparoscopic CME via dorsal-medial hybrid approach for right colon cancer could have less laparoscopic dissection time, and two approaches were similar in CME quality, safety and prognosis.

Key words: Colon cancer, Complete mesocolic excision, Laparoscopic radical resection for right colon cancer, Dorsal-medial hybrid approach, Traditional medial approach

中图分类号:

R735.3⁺5

刘海山, 蔡正昊, 马君俊, 孙晶, 何子锐, 臧潞, 董峰, 冯波, 宗雅萍, 薛佩, 张鲁阳, 陆爱国, 郑民华. 腹腔镜右半结肠癌完整系膜切除术经尾侧-中间联合入路回顾性研究[J]. 外科理论与实践, 2020, 25(03): 211-216.

LIU Haishan, CAI Zhenghao, MA Junjun, SUN Jing, HE Zirui, ZANG Lu, DONG Feng, FENG Bo, ZONG Yaping, XUE Pei, ZHANG Luyang, LU Aiguo, ZHENG Minhua. A retrospective study on laparoscopic complete mesocolic excision via dorsal-medial hybrid approach for right colon cancer[J]. Journal of Surgery Concepts & Practice, 2020, 25(03): 211-216.

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项目	尾侧联合入路（n=37)	中间入路（n=31)	P值
年龄（岁）	63.38±11.37	64.26±15.22	0.78
性别（男/女）	17/20	18/13	0.34
BMI	23.50±3.18	22.90±5.25	0.56
腹部手术史			0.69
无	29	23
有	8	8
ASA分级			0.80
Ⅰ	7	4
Ⅱ	22	20
Ⅲ	8	7
肿瘤部位			0.23
回盲部	8	9
升结肠	9	6
肝曲及横结肠	20	16
术后辅助治疗			0.38
无	23	16
有	14	15

项目	尾侧联合入路（n=37)	中间入路（n=31)	P值
腺癌			0.06
低分化	3	10
中分化	29	16
高分化	2	2
黏液腺癌	3	3
T分期			0.38
T₂	4	2
T₃	29	22
T₄	4	7
N分期			0.23
N₀	28	18
N₁	8	10
N₂	1	3
分期			0.53
Ⅰ	4	2
Ⅱ	22	16
Ⅲ	11	13

项目	尾侧联合入路 (n=37)	中间入路 (n=31)	P值
总手术时间（min)	134.59±38.56	144.93±43.98	0.79
腹腔镜下解剖时间（min）	62.70±12.22	70.39±11.98	0.01
出血量（mL）	30.41±29.64	38.23±24.34	0.25
术后排气时间（d）	2.78±0.79	2.81±0.83	0.91
术后住院时间（d）	7.91±1.57	8.00±1.56	0.82
术后近期并发症	4（10.8%）	2（6.5%）	0.68
切口并发症	1	1
吻合口漏	0	1
肠梗阻	2	0
出血	1	0

项目	尾侧联合入路 (n=37)	中间入路 (n=31)	P值
CME完成率	86.5%（32）	80.6%（25）	0.53
系膜完整性分级
系膜层面（a级）	32	25
系膜内层面（b级）	5	6
切除系膜面积（cm²）	104.92±29.84	106.33±30.68	0.86
血管结扎部位
A线(cm)	9.77±2.42	10.24±1.97	0.43
B线(cm)	8.39±2.04	8.72±1.66	0.51
切除结肠长度（cm)	17.45±4.72	19.98±4.99	0.47
淋巴结清扫数(枚）	20.93±6.34	20.29±6.83	0.71