Department of Digestive Surgery, Saku Central Hospital, 197 Usuda, Saku-City, Nagano, 384-0301, Japan.
Surg Endosc. 2011 May;25(5):1659-60. doi: 10.1007/s00464-010-1439-6. Epub 2010 Oct 29.
Radical lymphadenectomy for advanced colon cancer performed via the medial approach improves oncologic outcomes. However, D3 radical lymphadenectomy possesses some unresolved problems such as the complicated vascular anatomy and concerns over surgical morbidity [1-5]. The authors present a simple and safe procedure for laparoscopic right or left hemicolectomy using a medial approach to overcome these problems. The key characteristic of their procedure is separation of the mesocolon into two layers along the superior or inferior mesenteric artery, showing the course of these branches under the mantle of the vascular sheath. This procedure resembles filleting fish into two pieces.
Between October 2009 and March 2010, 11 consecutive patients with advanced colon cancer underwent a curative laparoscopic right (n=5) or left (n=6) hemicolectomy via a medial approach by a single surgeon. The body mass image (BMI) for the 11 patients ranged from 22 to 32 kg/m2. With this procedure, the D3 lymphadenectomy procedure is performed first [6]. The mesocolon is dissected between the superficial layer of the fat tissue and the deep layer of the vascular sheath along the superior or inferior mesenteric artery. After the course of each branch is exposed, each supplying or draining vessel is transected at its root [7, 8]. The use of a laparoscope and a spatula-type electric cautery greatly contributes to this procedure [9]. Next, the bowel is mobilized, and the specimen is retrieved through the small incision. Finally, extra- or intracorporeal anastomosis is performed.
No intraoperative complications occurred. The median number of retrieved lymph nodes was 23 (range, 13-52). The median total operative time was 220 min (range, 145-318 min), and the intraoperative blood loss was minimal (range, 0-70 g). The postoperative course was uneventful for all the patients.
The authors consider the described method to be simple and safe for radical lymphadenectomy during a laparoscopic right or left hemicolectomy.
通过内侧入路对晚期结肠癌进行根治性淋巴结清扫可改善肿瘤学结果。然而，D3 根治性淋巴结清扫术存在一些尚未解决的问题，例如血管解剖结构复杂和对手术发病率的担忧[1-5]。作者提出了一种简单而安全的腹腔镜右或左半结肠切除术方法，通过内侧入路克服这些问题。该手术的关键特点是沿肠系膜上动脉将系膜分为两层，显示这些分支在血管鞘的掩护下的走行。这个过程类似于将鱼切成两片。
2009 年 10 月至 2010 年 3 月，由一名外科医生对 11 例晚期结肠癌患者进行了腹腔镜右（n=5）或左（n=6）半结肠切除术的内侧入路治疗。这 11 例患者的体质指数（BMI）范围为 22 至 32kg/m2。采用该方法，首先进行 D3 淋巴结清扫术[6]。沿肠系膜上动脉将系膜在浅层脂肪组织和深层血管鞘之间解剖。在暴露每个分支的走行后，在根部切断每个供应或引流血管[7,8]。腹腔镜和刮匙型电凝术的使用对该手术有很大帮助[9]。然后，将肠管游离，从小切口取出标本。最后，进行额外或体内吻合。
无术中并发症发生。所切除的淋巴结中位数为 23 个（范围为 13-52 个）。中位总手术时间为 220 分钟（范围为 145-318 分钟），术中出血量极少（范围为 0-70 克）。所有患者术后恢复顺利。
作者认为，对于腹腔镜右或左半结肠切除术的根治性淋巴结清扫术，该方法简单、安全。
