[1]徐李帅 胡昊 杨成 符清胜 汪嘉伟 张旭 黄晓旭 许力**.改良肠系膜上动脉入路完全腹腔镜右半结肠癌根治术[J].中国微创外科杂志,2024,01(5):334-338.
　Xu Lishuai,Hu Hao,Yang Cheng,et al.Modified Superior Mesenteric Artery Approach Totally Laparoscopic Radical Resection for Right Colon Cancer[J].Chinese Journal of Minimally Invasive Surgery,2024,01(5):334-338.
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改良肠系膜上动脉入路完全腹腔镜右半结肠癌根治术()
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《中国微创外科杂志》[ISSN:1009-6604/CN:11-4526/R]

卷:
01
期数:
2024年5期
页码:
334-338
栏目:
临床研究
出版日期:
2024-05-25

文章信息/Info

Title:
Modified Superior Mesenteric Artery Approach Totally Laparoscopic Radical Resection for Right Colon Cancer
作者:
徐李帅 胡昊 杨成 符清胜 汪嘉伟 张旭 黄晓旭 许力**
(皖南医学院第一附属医院胃肠外科，芜湖241000)
Author(s):
Xu Lishuai;  Hu Hao;  Yang Cheng;  et al.
Department of Gastrointestinal Surgery, First Affiliated Hospital of Wannan Medical College, Wuhu 241000, China
关键词:
右半结肠癌; 肠系膜上动脉; D3淋巴结清扫
Keywords:
Right colon cancer; Superior mesenteric artery; D3 lymphadenectomy自2009年Hohenberger
文献标志码:
A
摘要:
目的探讨改良肠系膜上动脉(superior mesenteric artery，SMA)入路完全腹腔镜右半结肠癌完整结肠系膜切除(complete mesocolic excision，CME)、D3根治术的安全性和可行性。方法回顾性分析2021年4月~2023年4月完全腹腔镜右半结肠癌根治术77例临床资料。2022年8月前42例行传统SMA入路(对照组，仅以回结肠血管蒂为SMA尾侧标识)，2022年8月后35例行改良SMA入路(改良组，以屈氏韧带和回结肠血管蒂分别为SMA的头、尾侧标识)。2组一般资料差异无统计学意义(P>0.05)。比较2组术中情况、术后恢复及术后并发症情况。结果与对照组相比，改良组手术时间短［(147.3±35.8)min vs.(173.4±29.9)min，t=-3.428，P=0.001］，2组淋巴结清扫数目、阳性淋巴结数目、引流量、排气时间、术后住院时间及并发症发生率均无显著性差异(P>0.05)。结论改良SMA入路行完全腹腔镜右半结肠癌根治术可缩短手术时间，降低手术难度和风险，安全性和可行性更高。
Abstract:
ObjectiveTo explore the safety and feasibility of a modified superior mesenteric artery (SMA) approach in totally laparoscopic complete mesocolic excision (CME) and D3 lymphadenectomy for right colon cancer.MethodsA retrospective analysis was performed on clinical data of 77 cases of totally laparoscopic radical surgery for right colon cancer from April 2021 to April 2023. Before August 2022, 42 cases underwent traditional SMA approach (control group, only marking with the ileocolic vascular pedicle as the tail of SMA), while after August 2022, 35 cases underwent modified SMA approach (modified group, marking with the Treitz’s ligament and ileocolic vascular pedicle as the head and tail of SMA, respectively). There was no statistically significant difference in general information between the two groups (P>0.05). The intraoperative conditions, postoperative recovery, and postoperative complications were compared between the two groups. ResultsCompared with the control group, the modified group had a shorter surgical time ［(147.3±35.8) min vs. (173.4±29.9) min, t=-3.428, P=0.001］. There were no statistically significant differences in the number of lymph node dissection, number of positive lymph nodes, drainage volume, exhaust time, postoperative hospital stay, and incidence of complications between the two groups (P>0.05).ConclusionThe modified SMA approach for totally laparoscopic radical resection of right colon cancer shortens the surgical time, reduces the difficulty and risk of surgery, and has high safety and feasibility.

参考文献/References:

[1]Hohenberger W,Weber K,Matzel K,et al.Standardized surgery for colonic cancer:complete mesocolic excision and central ligation:technical notes and outcome.Colorectal Dis,2009,11(4):354-364.
[2]徐瑞华,李进.中国临床肿瘤学会(CSCO)结直肠癌诊疗指南2023.北京:人民卫生出版社,2023.50-51.
[3]West NP,Hohenberger W,Weber K,et al.Complete mesocolic excision with central vascular ligation produces an oncologically superior specimen compared with standard surgery for carcinoma of the colon.J Clin Oncol,2010,28(2):272-278.
[4]De Lange G,Davies J,Toso C,et al.Complete mesocolic excision for right hemicolectomy:an updated systematic review and metaanalysis.Tech Coloproctol,2023,27(11):979-993.
[5]Hashiguchi Y,Muro K,Saito Y,et al.Japanese Society for Cancer of the Colon and Rectum (JSCCR) guidelines 2019 for the treatment of colorectal cancer.Int J Clin Oncol,2020,25(1):1-42.
[6]West NP,Kobayashi H,Takahashi K,et al.Understanding optimal colonic cancer surgery:comparison of Japanese D3 resection and European complete mesocolic excision with central vascular ligation.J Clin Oncol,2012,30(15):1763-1769.
[7]郭释琦,崔明明,刘鼎盛,等.腹腔镜右半结肠切除术中血管解剖辨识及意义研究.中国实用外科杂志,2021,41(9):1017-1023.
[8]马冰,杜晓辉,夏绍友,等.回结肠血管为入路标志的腹腔镜辅助下右半结肠根治术24例报告.中国微创外科杂志,2013,13(6):481-484.
[9]孙跃明,张冬生.右半结肠癌CME/D3根治术淋巴结清扫内侧界的争议.外科理论与实践,2023,28(3):202-207.
[10]Luo W,Cai Z,Li F,et al.Laparoscopic complete mesocolic excision with central vascular ligation (CME+CVL) for rightsided colon cancer:a new “superior mesenteric artery first” approach.Ann Surg Oncol,2022,29(8):5066-5073.
[11]孙然,陈明,陈云.不同内侧界右半结肠癌D3淋巴结清扫前瞻性对比研究.中华普通外科学文献(电子版),2023,17(1):59-62.
[12]吴国聪,张忠涛.完全腹腔镜技术在根治性右半结肠切除术中的应用.中华结直肠疾病电子杂志,2015,4(3):59-61.
[13]冯波,周乐其.右半结肠癌D3淋巴结清扫范围及入路选择.中国实用外科杂志,2020,40(3):274-278.
[14]谢斌耀,李世红,任旭.腹腔镜技术用于右半结肠癌手术的安全性及入路分析.中华普外科手术学杂志(电子版),2019,13(5):458-460.
[15]O’Cormell JB,Maggard MA,Ko CY,et al.Colon cancer survival rates with the new American Joint Committee on Cancer sixth edition staging.J Natl Cancer Inst,2004,96(19):1420-1425.
[16]Yi X,Li H,Lu X,et al.“Caudaltocranial” plus “artery first” technique with beyond D3 lymph node dissection on the right midline of the superior mesenteric artery for the treatment of right colon cancer: is it more in line with the principle of oncology?Surg Endosc,2020,34(9):4089-4100.
[17]Chaturvedi R,Burton BN,Gabriel RA.Complication rates and the benefits of neuraxial anesthesia in the patient with high comorbidity burden undergoing primary total joint arthroplasty.J Arthroplasty,2020,35(11):3089-3092.
[18]林羽,陈致奋,孙艳武,等.结直肠癌术后乳糜漏的治疗.结直肠肛门外科,2022,28(3):217-220.

备注/Memo

备注/Memo:
基金项目：国家自然科学基金(82372707)；安徽省高校自然科学研究项目(2023AH051771)；安徽省卫生健康委科研项目(AHWJ2023A10126)**通讯作者，Email：xulixuli1973@163.com
更新日期/Last Update: 2024-08-06