腹腔镜辅助右半结肠根治术 D3 淋巴结清扫术的长期疗效：177 例临床分析。
Long-term results of laparoscopy-assisted radical right hemicolectomy with D3 lymphadenectomy: clinical analysis with 177 cases.
机构信息
Department of General Surgery, Ruijin Hospital, Shanghai Minimally Invasive Surgery Center, Shanghai Jiaotong University School of Medicine, Shanghai 200025, People's Republic of China.
出版信息
Int J Colorectal Dis. 2013 May;28(5):623-9. doi: 10.1007/s00384-012-1605-5. Epub 2012 Nov 2.
PURPOSES
To study the feasibility, safety, and short-/long-term outcomes of laparoscopy-assisted right hemicolectomy with D3 lymphadenectomy for colon cancer.
METHODS
The clinical data of 177 cases that underwent laparoscopy-assisted radical right hemicolectomy with D3 lymphadenectomy for colon cancer between Jun 2003 and Sep 2010 was collected; the safety of operation, status of recovery, complication, oncological outcomes, and results of short-/long-term follow-up were analyzed.
RESULTS
No case died in this study; five cases (2.82 %) were converted to open surgery. Four cases (2.26 %) underwent hand-assisted laparoscopic right hemicolectomy. The average operation time was 133 ± 36 min, and the blood loss was 94 ± 34 ml. The average time for passage of flatus, liquid food eating, and hospitalization were 2.1 ± 0.7, 3.2 ± 0.5, and 10.4 ± 2.7 day, respectively. The total number of lymph nodes removed was 15.2 ± 10.1. Postoperative complications were observed in 23 of 177 patients (12.99 %). The median follow-up period was 54 months; port-site recurrence was observed in one patient; local recurrence was found in five cases (2.82 %); distant metastasis was found in 21 cases (11.86 %). The cumulative overall survival of all stages at 12, 36, 60, and 72 months was 97.18 %, 83.73 %, 70.37 %, and 68.99 %, respectively. The cancer-specific survival was 98.73 % (12 months), 87.81 % (36 months), and 80.17 % (60 months).
CONCLUSIONS
Laparoscopy-assisted right hemicolectomy with D3 lymphadenectomy can be successfully performed for right colon cancer with the advantages of minimally invasive surgery. Moreover, the results implied appropriate short- and long-term outcomes.
目的
研究腹腔镜辅助右半结肠切除术联合 D3 淋巴结清扫术治疗结肠癌的可行性、安全性及短期和长期疗效。
方法
回顾性分析 2003 年 6 月至 2010 年 9 月期间 177 例行腹腔镜辅助右半结肠切除术联合 D3 淋巴结清扫术治疗结肠癌患者的临床资料，分析手术安全性、恢复情况、并发症、肿瘤学疗效及短期和长期随访结果。
结果
本研究无死亡病例，中转开腹 5 例（2.82%），手辅助腹腔镜右半结肠切除术 4 例（2.26%）。手术时间平均 133±36min，术中出血量平均 94±34ml。术后肛门排气时间、开始进流食时间及住院时间分别为 2.1±0.7、3.2±0.5、10.4±2.7d。平均清扫淋巴结 15.2±10.1 枚。术后并发症 23 例（12.99%）。中位随访时间 54 个月，1 例患者出现切口部位复发，5 例（2.82%）患者出现局部复发，21 例（11.86%）患者出现远处转移。Ⅰ、Ⅱ、Ⅲ期患者的 1 年、3 年、5 年累积总生存率分别为 97.18%、83.73%、70.37%和 97.18%、83.73%、70.37%，5 年累积无病生存率分别为 97.18%、83.73%、70.37%和 97.18%、83.73%、70.37%。
结论
腹腔镜辅助右半结肠切除术联合 D3 淋巴结清扫术治疗右半结肠癌安全可行，具有微创优势，近期和远期疗效满意。
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