[1]刘祖定﹡ 伍家发 刘中宁 陈翌 黄永柱 刘滨洋 姚松良.腹腔镜中间入路逆行法右半结肠癌D3根治术的手术要点与难点分析[J].中国微创外科杂志,2014,14(8):741-754.
　Liu Zuding,Wu Jiafa,Liu Zhongning,et al.Analysis of Features and Difficulties of Laparoscopic Medialtolateral Approach Retrograde Right Hemicolectomy with D3 Lymphadenectomy[J].Chinese Journal of Minimally Invasive Surgery,2014,14(8):741-754.
点击复制

腹腔镜中间入路逆行法右半结肠癌D3根治术的手术要点与难点分析()
分享到：

《中国微创外科杂志》[ISSN:1009-6604/CN:11-4526/R]

卷:
14
期数:
2014年8期
页码:
741-754
栏目:
短篇论著
出版日期:
2014-08-20

文章信息/Info

Title:
Analysis of Features and Difficulties of Laparoscopic Medialtolateral Approach Retrograde Right Hemicolectomy with D3 Lymphadenectomy
作者:
刘祖定﹡ 伍家发 刘中宁 陈翌 黄永柱 刘滨洋 姚松良
广西壮族自治区桂林市第二人民医院普外科，桂林541001
Author(s):
Liu Zuding;  Wu Jiafa;  Liu Zhongning;  et al.
Department of General Surgery, Second People’s Hospital of Guilin, Guilin 541001, China
关键词:
中间入路逆行法; 右半结肠癌D3根治术; 腹腔镜
Keywords:
Intermediate approach of retrograde resection; Right hemicolectomy with D3 lymphadenectomy; Laparoscopy
分类号:
R735.3+5
文献标志码:
A
摘要:
目的探讨腹腔镜中间入路逆行法右半结肠癌D3根治术的手术方法。方法2008年11月~2012年6月，对20例回盲部、升结肠、结肠肝曲癌，采用腹腔镜中间入路逆行法，以解剖肠系膜上静脉进行淋巴结清扫，进入正确的外科平面，最后离断外周固定装置而行右半结肠切除术。结果17例用腹腔镜中间入路逆行法完成手术，3例中转开腹（1例游离肠系膜血管根部时出血，2例腹腔粘连）。17例腹腔镜手术时间126~186 min，平均145.3 min，术中出血60~200 ml，平均85 ml，清扫淋巴结12～18枚，平均16.5枚，阳性淋巴结0~7枚，平均4.4枚，术后24~72 h恢复胃肠功能，术后住院8~13 d，平均11 d，均顺利恢复，术后切缘病理均无肿瘤残余。术后均予以化疗，随访6~26个月，平均20个月，无复发、转移。结论掌握腹腔镜中间入路逆行法右半结肠癌D3根治术的要点与难点，可简化手术程序，节省手术时间，改善手术效果，该方法安全、有效，易于推广。
Abstract:
ObjectiveTo explore the features and difficulties of laparoscopic medialtolateral approach retrograde right hemicolectomy with D3 lymphadenectomy. MethodsA total of 20 patients with rightsided colon cancer, at the site of ileocecum, ascending colon, or colon near the liver, underwent the laparoscopic medialtolateral approach retrograde operations from November 2008 to June 2012. After the dissection of mesenteric vessels and lymphadenectomy, the right surgical plane was guided by the landmark of the superior mesenteric vein (SMV). Then the peripheral attachments were divided for right hemicolectomy.ResultsAmong the 20 cases, laparoscopic medialtolateral approach retrograde surgery was completed in 17 cases, while a conversion to open surgery was needed in 3 cases (because of bleeding in 1 case and of adhesion in 2 cases). The laparoscopic operation time was 126-186 min (mean, 145.3 min), the intraoperative blood loss was 60-200 ml (mean, 85 ml), the number of lymph nodes harvested was 12-18 (mean, 16.5), the number of positive lymph nodes was 0-7 (mean, 4.4), the time of resumption of gastrointestinal function was 24-72 h, and the length of hospital stay after operation was 8-13 d (mean, 11 day). All the patients were recovered smoothly. There were no residual tumor at the resection margin according to postoperative pathological examinations. Chemotherapy was given in all the patients after operation. The patients were followed for 6-26 months (mean 20 months), with no recurrence and metastasis.ConclusionsUnderstanding the features and difficulties of laparoscopic medialtolateral approach retrograde operation is helpful to facilitate operating performance, shorten the operation time, and improve the surgical effects. This method is a feasible and safe procedure, being easy to popularize.

参考文献/References:

[1]Jacobs M,Verdeja JC，Goldstein HS.Minimally invasive colon resection (laparoscopic colectomy).Surg Laparosc Endosc,1991,1(3):144-150.
[2]包炎毅，阎波，朱雯怡，等.腹腔镜辅助右半结肠切除术21例报告.中国微创外科杂志，2008,8（5）:399-400.
[3]刘蔚东,张阳德,Choi Gyuseog,等.腹腔镜下右半结肠癌D3根治术.中国微创外科杂志，2007,7（6）：499-501.
[4]Mamsch F，Gastinger I，Schneider C,et al.Experience as a factor influencing the indications for laparoscopic colorectal surgery and the results.Surg Endosc,2001,15（2）：116-120.
[5]徐琳,刘宝善.右半结肠癌顺行与逆行淋巴结清扫切除术疗效比较.四川医学,2007,28(9):1013-1015.
[6]Park KJ, Choi HJ, Roh MS,et al. Intensity of tumor budding and its prognostic implications in invasive colon carcinoma.Dis colon Rectum，2005,48(8):1597-1602.
[7]于海涛,李国新,张策,等.腹腔镜中间入路法右半结肠切除术解剖学观察.中国临床解剖学杂志,2008，26（5）：477-480.
[8]吕俊生,慕星,王文超,等.腹腔镜辅助下结直肠癌手术32例.中国微创外科杂志,2012,12（10）:947-948.

备注/Memo

备注/Memo:
滕洪通讯作者，Email：hong_teng1961@163.com王述民曲家骐侯维平高昕芦佳(沈阳军区第463医院放射诊断科，沈阳110042)（沈阳军区总医院胸外科，沈阳110016）【摘要】目的探讨胸腔镜手术治疗老年肺气肿自发性气胸的适应证和手术方法。方法1994年9月~2011年12月，胸腔镜手术治疗43例老年肺气肿自发性气胸。单发或成簇大疱者行完全胸腔镜手术（videoassisted thoracoscopic surgery，VATS），多发肺大疱和经济较困难者行胸腔镜辅助小切口手术（v
更新日期/Last Update: 2015-06-04