切换至 "中华医学电子期刊资源库"

中华结直肠疾病电子杂志 ›› 2020, Vol. 09 ›› Issue (05) : 453 -459. doi: 10.3877/cma.j.issn.2095-3224.2020.05.004

所属专题: 文献

论著

腹腔镜右半结肠癌根治术优先处理Henle干的近期疗效分析
杨飖1, 严东羿1, 袁彪1, 曹东亮1, 崔锡茂1, 蒋小华1,(), 宋纯1,()   
  1. 1. 200123 上海,同济大学附属东方医院胃肠外科
  • 收稿日期:2020-03-23 出版日期:2020-10-25
  • 通信作者: 蒋小华, 宋纯
  • 基金资助:
    国家自然科学基金面上项目(No. 81672733); 2017上海市浦东新区卫生系统特色专病(胃癌)(No. PWZzb2017-5)

Analysis of the short-term clinical efficacy of the prior approach of Henle trunk in laparoscopic right hemi-colectomy for right colon cancer

Yao Yang1, Dongyi Yan1, Biao Yuan1, Dongliang Cao1, Ximao Cui1, Xiaohua Jiang1,(), Chun Song1,()   

  1. 1. Department of Gastrointestinal Surgery, Shanghai East Hospital, Shanghai 200123, China
  • Received:2020-03-23 Published:2020-10-25
  • Corresponding author: Xiaohua Jiang, Chun Song
  • About author:
    Corresponding author: Jiang Xiaohua, Email:
    Song Chun, Email:
引用本文:

杨飖, 严东羿, 袁彪, 曹东亮, 崔锡茂, 蒋小华, 宋纯. 腹腔镜右半结肠癌根治术优先处理Henle干的近期疗效分析[J]. 中华结直肠疾病电子杂志, 2020, 09(05): 453-459.

Yao Yang, Dongyi Yan, Biao Yuan, Dongliang Cao, Ximao Cui, Xiaohua Jiang, Chun Song. Analysis of the short-term clinical efficacy of the prior approach of Henle trunk in laparoscopic right hemi-colectomy for right colon cancer[J]. Chinese Journal of Colorectal Diseases(Electronic Edition), 2020, 09(05): 453-459.

目的

对比胃结肠静脉干(Henle干)的优先处理与传统处理在腹腔镜右半结肠癌根治术的近期疗效分析。

方法

回顾性分析2018年6月至2019年6月期间同济大学附属上海东方医院胃肠外科80例行腹腔镜右半结肠癌根治术治疗结肠癌的临床资料,根据手术视频录像筛选,术中优先处理Henle干38例(优先组),同期未优先处理Henle干(传统组)42例,比较两组的手术安全性及其近期疗效。

结果

两组患者年龄、性别、体质量指数、肿瘤部位、肿瘤直径、肿瘤分期经比较,差异均无统计学意义(P>0.05)。与传统组相比,优先组术中出血量减少[(62.89±29.31)mL vs.(86.90±33.89)mL,t=3.372;P=0.001],手术时间缩短[(146.61±10.40)min vs.(159.21±21.60)min,t=3.270;P=0.002],术中血管损伤率降低[5.3%(2/38)vs. 21.4%(9/42),χ2=4.396;P=0.036];两组术后并发症发生率、术后首次排气时间、术后首次排便时间、术后引流时间、术后住院时间、手术标本质量评价及病理学检查结果经比较,差异均无统计学意义(P>0.05)。

结论

两组手术方式均为符合肿瘤根治性原则的有效手术,手术效果相当。在腹腔镜右半结肠癌根治术中优先处理Henle干在减少术中出血量,缩短手术时间,减少术中血管损伤方面具有优势,是安全可行的手术方式。

Objective

To compare the short-term clinical efficacy between prior and traditional approach of Henle trunk in laparoscopic right hemi-colectomy for right colon cancer.

Methods

Between June 2018 and June 2019, eighty cases who underwent laparoscopic right hemi-colectomy for right colon cancer in Gastrointestinal Surgery Department of Shanghai East Hospital Affiliated to Tongji University. According to the screening of operation videos, thirty-eight cases were given prior approach of Henle trunk (priority group) during the operation, while 42 cases (traditional group) were not given priority at the same time. A comparative, retrospective analysis was performed between the two groups in operative safety index and efficacy.

Results

Age, gender, body mass index, tumor location, diameter of tumor, tumor stage were not significantly different between the two groups (P>0.05). As compared to the traditional group, priority group was associated with significantly less estimated mean blood loss [(62.89±29.31) mL vs. (86.90±33.89)mL, t=3.372; P=0.001], shorter operative time [(146.61±10.40) min vs. (159.21±21.60) min, t=3.270; P=0.002], and lower intraoperative vascular damage rate [5.3% (2/38) vs. 21.4% (9/42), χ2=4.396; P=0.036]. There were no significantly differences between these two groups in terms of postoperative complications, first exhaust time, initial defecaton time, drainage time, postoperative hospitalization time, quality evaluation of surgical specimens and results of pathological examination.

Conclusion

By using both two surgical approaches, radical resection of tumors could be achieved effectively in accordance with the principles of CME, and the operative effect was comparable. The prior process of Henle trunk in laparoscopic right hemi-colectomy for right colon cancer has advantages in less estimated blood loss, shorter operative time and lower intraoperative vascular damage rate. It is a safe and reliable treatment.

表1 优先处理与传统处理两组患者一般资料比较(±s
图1 5孔法示意图。腹腔镜屏幕位于患者右前方,术者站立于患者左侧,扶镜手站立于术者左侧,第一助手站立于患者两腿之间,在行中间入路清扫淋巴结时术者与一助互换位置
图2 头侧-尾侧联合中间入路。2A:头侧入路,游离横结肠系膜与胃之间的融合区域;2B:头侧入路时解剖Henle干及其各属支;2C:离断副右结肠静脉;2D:以肠系膜上静脉(SMV)投影切迹,做好预切开标记;2E:尾侧入路,提起末端回肠系膜,以回肠系膜背侧附着部及十二指肠连线位置,切开腹膜;沿Tlodt's间隙向头侧拓展,与头侧分离间隙会师,完全游离右半结肠肠管及系膜;2F:以肠系膜上静脉左侧为界清扫淋巴结,离断回结肠血管;2G:离断结肠中动脉;2H:离断结肠中静脉;2I:清扫区域的展示。RGEV:胃网膜右静脉,ASPDV:胰十二指肠上前静脉,MCV:结肠中静脉,MCA:结肠中动脉,SMA:肠系膜上动脉,SRCV:副右结肠静脉,HT:Henle干
表2 优先组与传统组患者术中及术后评价指标比较
表3 优先处理与传统处理两组患者术后病理学检查结果比较
[1]
Watanabe T, Itabashi M, Shimada Y, et al. Japanese Society for Cancer of the Colon and Rectum(JSCCR) guidelines 2010 for the treatment of colorectal cancer [J]. Int J Clin Oncol, 2012, 17(1): 1-29.
[2]
Benson AB, Venook AP, Cederquist L, et al. Colon cancer, version 1.2017, nccn clinical practice guidelines in oncology [J]. J Natl Compr Canc Netw, 2017, 15(3): 370-398.
[3]
Henle J. Handbuchder systematischen anatomie des menschen[M]. Ⅲ (1.handbuchder Gefaesslehre des Menschen note 1), Braunschweig: : Friedrich Vieweg & Sohn, 1868.
[4]
Gillot C, Hureau J, Aaron C, et al. The superior mesenteric vein, an anatomic and surgical study of eighty-one subjects[J]. J Int Coll Surg, 1964, 41: 339-369.
[5]
肖毅. 优化腹腔镜右半结肠切除术血管损伤的预防和处理策略[J].中华外科杂志, 2018, 56(8): 573-577.
[6]
Matsuda T, Iwasaki T, Sumi Y, et al. Laparoscopic complete mesocolic excision for right-sided colon cancer using a cranial approach: anatomical and embryological consideration[J]. Int J Colorectal Dis, 2017, 32(1): 139-141.
[7]
Matsuda T, Iwasaki T, Mitsutsuji M, et al. Cranial-to-caudal approach for radical lymph node dissection along the surgical trunk in laparoscopic right hemicolectomy [J]. Surg Endosc, 2015, 29(4): 1001.
[8]
Hohenberger W, Weber K, Matzel K, et al. Standardized surgery for colonic cancer: complete mesocolic excision and central ligation--technical notes and outcome [J]. Colorectal Dis, 2009, 11(4): 354-365.
[9]
冯波,韩丁培,郑民华,等.中间入路腹腔镜下行完整结肠系膜切除根治右半结肠癌35例可行性与技术要点分析[J].中国实用外科杂志, 2012, 32(4): 323-326.
[10]
West NP, Morris EJ, Rotimi O, et al. Pathology grading of colon cancer surgical resection and its association with survival: a retrospective observational study[J]. Lancet Oncol, 2008, 9(9): 857-865.
[11]
冯波,严夏霖,张森,等. 腹腔镜右半结肠癌根治术Henle干的解剖技巧[J].中华胃肠外科杂志, 2017, 20(6): 635-638.
[12]
Yamaguchi S, Kuroyanagi H, Milsom JW, et al. Venous anatomy of the right colon: precise structure of the major veins and gastrocolic trunk in 58 cadavers[J]. Dis Colon Rectum, 2002, 45(10): 1337-1340.
[13]
龚建平. 右半结肠癌根治术的外科膜解剖[J/CD]. 中华结直肠疾病电子杂志, 2015, 4(6): 600-601.
[14]
Freund MR, Goldin I, Reissman P. Superior mesenteric vein injury during oncologic right colectomy: current vascular repair modalities [J]. Vasc Endovascular Surg, 2018, 52(1): 11-15.
[15]
Turnbull RB Jr, Kyle K, Watson FR, et al. Cancer of the colon: the influence of the no-touch isolation technic on survival rates [J]. CA Cancer J Clin, 1968, 18(2): 82-87.
[16]
郑民华,马君俊. 腹腔镜右半结肠癌根治术的难点与争议[J/CD]. 中华普外科手术学杂志(电子版), 2018, 12(3): 181-184.
[1] 姚宏伟, 魏鹏宇, 高加勒, 张忠涛. 不断提高腹腔镜右半结肠癌D3根治术的规范化[J]. 中华普外科手术学杂志(电子版), 2024, 18(01): 1-4.
[2] 杜晓辉, 崔建新. 腹腔镜右半结肠癌D3根治术淋巴结清扫范围与策略[J]. 中华普外科手术学杂志(电子版), 2024, 18(01): 5-8.
[3] 周岩冰, 刘晓东. 腹腔镜右半结肠癌D3根治术消化道吻合重建方式的选择[J]. 中华普外科手术学杂志(电子版), 2024, 18(01): 9-13.
[4] 张焱辉, 张蛟, 朱志贤. 留置肛管在中低位直肠癌新辅助放化疗后腹腔镜TME术中的临床研究[J]. 中华普外科手术学杂志(电子版), 2024, 18(01): 25-28.
[5] 王春荣, 陈姜, 喻晨. 循Glisson蒂鞘外解剖、Laennec膜入路腹腔镜解剖性左半肝切除术临床应用[J]. 中华普外科手术学杂志(电子版), 2024, 18(01): 37-40.
[6] 李晓玉, 江庆, 汤海琴, 罗静枝. 围手术期综合管理对胆总管结石并急性胆管炎患者ERCP +LC术后心肌损伤的影响研究[J]. 中华普外科手术学杂志(电子版), 2024, 18(01): 57-60.
[7] 甄子铂, 刘金虎. 基于列线图模型探究静脉全身麻醉腹腔镜胆囊切除术患者术后肠道功能紊乱的影响因素[J]. 中华普外科手术学杂志(电子版), 2024, 18(01): 61-65.
[8] 逄世江, 黄艳艳, 朱冠烈. 改良π形吻合在腹腔镜全胃切除消化道重建中的安全性和有效性研究[J]. 中华普外科手术学杂志(电子版), 2024, 18(01): 66-69.
[9] 曹迪, 张玉茹. 经腹腔镜生物补片修补直肠癌根治术后盆底疝1例[J]. 中华普外科手术学杂志(电子版), 2024, 18(01): 115-116.
[10] 李凯, 陈淋, 向涵, 苏怀东, 张伟. 一种U型记忆合金线在经脐单孔腹腔镜阑尾切除术中的临床应用[J]. 中华普外科手术学杂志(电子版), 2024, 18(01): 15-15.
[11] 李三祥, 李佳, 刘俊峰, 吕东晨, 方晖东, 谭朝晖, 刘杰, 潘佐, 乔建坤. 基于CT影像的三维重建成像技术在腹腔镜大肾上腺肿瘤切除术中的应用[J]. 中华腔镜泌尿外科杂志(电子版), 2023, 17(06): 570-574.
[12] 赵佳晖, 王永兴, 彭涛, 李明川, 魏德超, 韩毅力, 侯铸, 姜永光, 罗勇. 后腹腔镜根治性肾切除手术时间延长和术中出血量增多的影响因素分析[J]. 中华腔镜泌尿外科杂志(电子版), 2023, 17(06): 575-580.
[13] 汪帮琦, 陈波特, 林浩坚, 许晖阳, 王镇伟, 袁雪峰, 林康健, 邱晓拂. 经腹入路3D腹腔镜联合输尿管硬镜同期处理肾盂输尿管连接部梗阻并肾盏结石的应用[J]. 中华腔镜泌尿外科杂志(电子版), 2023, 17(06): 597-600.
[14] 林文斌, 郑泽源, 郑文能, 郁毅刚. 外伤性脾破裂腹腔镜脾切除术患者中转开腹风险预测模型构建[J]. 中华肝脏外科手术学电子杂志, 2023, 12(06): 619-623.
[15] 牛朝, 李波, 张万福, 靳文帝, 王春晓, 李晓刚. 腹腔镜袖状胃切除联合胆囊切除治疗肥胖合并胆囊结石安全性和疗效[J]. 中华肝脏外科手术学电子杂志, 2023, 12(06): 635-639.
阅读次数
全文


摘要