【摘要】 目的:探讨经上下入路"翻页式"腹腔镜右半结肠D3根治性切除的手术路径要点及临床意义。方法:回顾分析2012年2月至2014年2月为102例右半结肠癌患者行经上下入路"翻页式"腹腔镜右半结肠D3根治术的临床资料。结果:95例(93.14%)患者顺利完成手术,7(6.86%)例中转开腹。术中清扫时间42~96 min,平均(78.2±11.3)min。术中出血量10~40 ml,平均(24.3±6.4)ml。清扫淋巴结11~46枚,平均(20.9±5.5)枚。术后肛门排气时间17 h~8 d,平均(64.8±27.3)h;术后住院7~13 d,平均(9.8±2.1)d。术后发生吻合口漏1例(0.98%)、切口脂肪液化2例(1.96%),均经治疗后痊愈,无围手术期死亡病例。结论:经上下入路"翻页式"腹腔镜右半结肠D3根治性切除术显露方便,对助手的腹腔镜经验要求较低,术中有良好的参照作为引导,清扫较流畅,很好地体现了"无瘤原则",达到了腹腔镜右半结肠D3根治手术的基本要求,且降低了腹腔镜右半结肠癌手术的难度,手术安全、可行,具有一定的临床实用价值。更多还原

【Abstract】 Objective: To investigate the value and approach of laparoscopic right hemicolectomy with D3lymphadenectomy from top to bottom. Methods: A retrospective analysis was carried out on clinical data of 102 patients who suffered from cancer of right hemicolon and received laparoscopic right hemicolectomy with D3lymphadenectomy from top to bottom from Feb. 2012 to Feb. 2014.Results: Laparoscopy was successfully performed in 95 patients( 93. 14%),7 cases( 6. 86%) were converted to open operation. The time of laparoscopic right hemicolectomy with D3lymphadenectomy was 42-96 min [average( 78. 2 ± 11. 3) min]. Blood loss was 10-40 ml with the average of( 24. 3 ± 6. 4) ml,average lymph node dissection number was( 20. 9 ± 5. 5),ranged from 11 to 46. Postoperative gastrointestinal function recovery time was( 64. 8 ± 27. 3) h( range 17 h to 8 d),mean postoperative hospital stay was( 9. 8 ±2. 1) d( range: 7-13 d). In the patients,postoperative anastomotic leak was found in 1 case( 0. 98%),incisional fat liquefaction in 2cases( 1. 96%),which were cured after treatment. No perioperative death occurred. Conclusions: The laparoscopic right hemicolectomy with D3lymphadenectomy from top to bottom is easy for exposure and clean,follows the principle of"no tumor",assistant does not have to be experienced,and there are favorable references as guidance. This procedure reduces the difficulty of the laparoscopic operation for right hemicolon cancer,which is safe and effective and has practical value in clinical application.更多还原