Abstract:

Clinical effects of laparoscopic surgery by medial-cephalo to lateral approach in the treatment of rectal cancer          LUO Yang, YU Min-hao, CHEN Jian-jun, et al. Department of Gastrointestinal Surgery, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai 200127, China
Corresponding author：ZHONG Ming, E-mail：drzhongming1966@163.com
Abstract    Objective    To evaluate the clinical effects of medial-cephalo to lateral approach for laparoscopic radical resection of rectal cancer. Methods    The clinical data of 132 rectal cancer patients，undergoing laparoscopic resection of rectal cancer in Renji Hospital, Shanghai Jiao Tong University School of Medicine from October 2016 to June 2017 were analyzed retrospectively，including 42 cases with medial-cephalo to lateral （MCL） group，35 cases with cephalo-medial to lateral （CML） group，and 55 cases traditional medial-lateral （ML） group. The clinical conditions during operation situations，postoperative situations and follow-up situations were compared among three groups. Results    The operative time was the highest in CML group（146.90±5.92）min，followed by the MCL group（127.50±4.18）min and the ML group（122.90±3.97）min（P=0.002）；In terms of the time of No.253 lymph node dissected，the CML group was lowest（11.91±0.38）min，followed by the MCL group（12.24±0.29）min and the ML group（15.76±0.44）min（P＜0.001）；Compared the number of No.253 lymph node dissected in the three group. The CML group was the best（2.929±0.190），followed by MCL group（2.686±0.220）and CM group（1.709±0.090）（P＜0.01）. While in other cases，such as volume of intraoperative blood loss，number of lymph node dissected and postoperative complications were no significant difference in the three group.Tumor recurrence，metastasis，and tumor-free death occurred during follow-up in all patients. What’s more，all patients had no tumor recurrence，no distant metastasis and no tumor-related death during follow-up. Conclusion    The medial-cephalo to lateral approach is safe and feasible for laparoscopic radical resection of rectal cancer，and an advantage of No.253 lymph node dissection，which cannot extend the operation time．

Key words: laparoscopic radical resection of rectal cancer, medial-cephalo to lateral approach, cephalo-medial to lateral approach, lymph node, dissection

摘要：

目的    探讨中间联合头侧入路在腹腔镜直肠癌手术的临床可行性和应用价值。方法    回顾性队列分析上海交通大学医学院附属仁济医院2016年10月至2017年6月间132例腹腔镜直肠癌根治术的临床资料（中间联合头侧组42例，头侧中间组35例，传统中间组55例），比较3组病人术中情况、术后恢复情况以及随访情况的变化。结果    在手术时间方面，头侧中间组用时最多［（146.90±5.92）min］，其次为中间联合头侧组［（127.50±4.18）min］，传统中间组花费时间最少［（122.90±3.97）min］（P=0.002）；在清扫No.253淋巴结所需时间上传统中间组［（11.91±0.38）min］＞中间联合头侧组［（12.24±0.29）min］＞头侧中间组［（15.76±0.44）min］（P＜0.001）；No.253淋巴结清扫数目方面，头侧中间组［（2.686±0.220）枚］及中间联合头侧组［（2.929±0.190）枚］均大于传统中间组［（1.709±0.09）枚］（P＜0.001）；而在术中出血量、淋巴结清扫总数以及术后并发症等方面差异无统计学意义。所有病人随访期间无肿瘤复发和转移，无肿瘤相关死亡。结论    中间联合头侧入路的腹腔镜直肠癌手术不仅可获得传统中间入路相同的效果，不会增加手术时间和手术难度，而且可以获得和头侧中间入路相似的No.253淋巴结清扫效果。

关键词: 腹腔镜直肠癌手术, 中间联合头侧入路, 头侧中间入路, 淋巴结清扫