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
Objective To 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.Methods A 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.Results Compared 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).Conclusion The 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.
基金项目
国家自然科学基金(82372707)
安徽省高等学校自然科学研究项目(2023AH051771)
安徽省卫生健康委科研项目(AHWJ2023A10126)
NETL
NSTL
维普
万方数据