中国实用外科杂志

中国实用外科杂志

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以肠系膜上动脉左侧为右半结肠癌D3根治术淋巴结清扫内侧界可行性研究

周乐其，冯    波，苏    浩，何子锐，张    森，马君俊，孙    晶，严夏霖，薛    佩，李健文，陆爱国，王明亮，郑民华   

  1. 上海交通大学医学院附属瑞金医院胃肠外科  上海市微创外科临床医学中心，上海  200025
  • 出版日期:2019-07-01 发布日期:2019-07-10

  • Online:2019-07-01 Published:2019-07-10

摘要：

目的    探讨以肠系膜上动脉（SMA）左侧为腹腔镜右半结肠癌D3根治术边界的手术可行性及短期疗效。方法    回顾性分析2015年6月至2017年3月上海交通大学医学院附属瑞金医院胃肠外科收治的行腹腔镜右半结肠癌D3根治术的134例病人，其中57例病人以SMA左侧为D3根治术的边界（SMA组），77例病人以肠系膜上静脉（SMV）左侧为D3根治术的边界（SMV组）。结果    两组病人的手术时间、术中出血量、术后排气时间、术后恢复饮水时间及术后住院天数差异均无统计学意义，但SMA组术后引流量和术后引流管放置时间均高于SMV组［（471.4±285.6）mL vs. （352.2±305.7）mL，（7.0±4.9）d vs. （5.7±2.0）d，P=0.023和P=0.037］。SMA组清扫淋巴结总数大于SMV组［（26.5±6.7）枚vs. （21.3±7.8）枚，P<0.0001］，其余术后病理学指标组间差异均无统计学意义。SMA组的术后并发症发生率高于SMV组（28.1% vs. 13.0%，P=0.045），乳糜漏和腹泻的发生率较高，但差异无统计学意义（8.8% vs. 1.3%，P=0.083；8.8% vs. 2.6%，P=0.135）。结论    以SMA左侧为边界行腹腔镜右半结肠癌D3根治术可清扫更多的淋巴结，但术后并发症发生率增高。

关键词: 右半结肠癌, D3淋巴结清扫, 完整结肠系膜切除, 肠系膜上动脉, 肠系膜上静脉

Abstract:

Surgical feasibility of laparoscopic D3 lymphadenectomy along the left of SMA for right colon cancer        ZHOU Le-qi，FENG Bo，SU Hao，et al. Department of Gastrointestinal Surgery，Ruijin Hospital，Shanghai Jiao Tong University School of Medicine; Shanghai Minimally Invasive Surgery Center，Shanghai 200025，China
Corresponding author：FENG Bo，E-mail: fengbo2022@163.com
Abstract    Objective    To investigate the feasibility and short-term outcomes of laparoscopic D3 lymphadenectomy along the left of SMA for right colon cancer. Methods    The clinical data of 134 patients with right colon cancer admitted from June 2015 to March 2017 in Department of Gastrointestinal Surgery，Ruijin Hospital，Shanghai Jiao Tong University School of Medicine were analyzed retrospectively. A total of 57 patients received the laparoscopic D3 lymphadenectomy along the left of SMA and 77 patients received the laparoscopic D3 lymphadenectomy along the left of SMV.  Results There was no statistical difference between the two groups in operation time，intra-operative blood loss，time of liquid intake and post-operative hospital stay，but the SMA group had a longer duration of tube drainage and larger total volume of drainage［（471.4±285.6）mL vs. （352.2±305.7）mL，（7.0±4.9）d vs. （5.7±2.0）d，P=0.02和P=0.03］. The SMA group harvested more lymph nodes than the SMV group（26.5±6.7 vs. 21.3±7.8，P<0.0001）. However，the SMA group had a higher rate of post-operative complications（28.1% vs. 13.0%，P=0.04）. Conclusion    Laparoscopic D3 lymphadenectomy along the left side of SMA for right colon cancer is feasible but had a higher rate of post-operative complications.

Key words: right colon cancer, D3 lymphadenectomy, complete mesocolic excision, superior mesenteric artery, superior mesenteric vein