Koinuma Koji, Horie Hisanaga, Ito Homare, Naoi Daishi, Sadatomo Ai, Tahara Makiko, Inoue Yoshiyuki, Kono Yoshihiko, Sasaki Takahiro, Sugimoto Hideharu, Lefor Alan Kawarai, Sata Naohiro
Department of Surgery, Jichi Medical University, Shimotsuke, Japan.
Department of Radiology, Jichi Medical University, Shimotsuke, Japan.
Asian J Endosc Surg. 2019 Apr;12(2):150-156. doi: 10.1111/ases.12628. Epub 2018 Jul 2.
Transverse colon resection is one of the most difficult laparoscopic procedures because of anatomic hazards such as variations in the mesenteric vascular anatomy and the complex structure of organs and surrounding membranes.
We evaluated the short-term surgical outcomes of laparoscopic transverse colon resection using a creative approach. This approach included preoperative surgical simulation using virtual surgical anatomy by CT, a four-directional approach to the mesentery, and 3-D imaging during laparoscopic surgery.
A total of 45 consecutive patients who underwent laparoscopic resection for transverse colon cancer from June 2013 to December 2017 were enrolled in this study. All procedures were completed safely, with minor postoperative complications, including two patients with anastomotic stenosis, two with intra-abdominal phlegmon, one with delayed gastric emptying, and one with pneumonia, all treated non-operatively. There were no conversions to open resection. Operation time was 203 min (range, 125-322 min), and the estimated blood loss during surgery was 5 mL (range, 0-370 mL). The mean postoperative hospital stay was 10 days (range, 7-21 days), and no patients required readmission.
Short-term surgical outcomes after laparoscopic transverse colon resection demonstrated that this creative approach was safe and feasible. The four-directional approach to the meso-transverse attachment combined with preoperative radiological simulation can facilitate laparoscopic transverse colon surgery.
由于存在诸如肠系膜血管解剖结构变异以及器官和周围膜结构复杂等解剖学风险，横结肠切除术是最具挑战性的腹腔镜手术之一。
我们采用一种创新方法评估腹腔镜横结肠切除术的短期手术效果。该方法包括利用CT虚拟手术解剖进行术前手术模拟、对肠系膜采用四向入路以及在腹腔镜手术期间进行三维成像。
本研究纳入了2013年6月至2017年12月期间连续45例行腹腔镜横结肠切除术治疗横结肠癌的患者。所有手术均安全完成，术后并发症轻微，包括2例吻合口狭窄、2例腹腔脓肿、1例胃排空延迟和1例肺炎，均经非手术治疗。无中转开腹手术情况。手术时间为203分钟（范围125 - 322分钟），术中估计失血量为5毫升（范围0 - 370毫升）。术后平均住院时间为10天（范围7 - 21天），无患者需要再次入院。
腹腔镜横结肠切除术后的短期手术效果表明，这种创新方法安全可行。对横结肠系膜附着处采用四向入路并结合术前影像学模拟可促进腹腔镜横结肠手术。
