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完全结肠系膜切除的腹腔镜右半结肠切除术的手术结果

Surgical Outcomes of Laparoscopic Right Colectomy with Complete Mesocolic Excision.

作者信息

Olmi Stefano, Oldani Alberto, Cesana Giovanni, Ciccarese Francesca, Uccelli Matteo, Giorgi Riccardo, Villa Roberta, Maria De Carli Stefano

机构信息

Department of General Surgery and Oncological Surgery, Advanced Laparoscopic and Bariatric Surgery Center, Policlinico San Marco, Zingonia (BG), Italy.

出版信息

JSLS. 2020 Apr-Jun;24(2). doi: 10.4293/JSLS.2020.00023.

Abstract

BACKGROUND AND OBJECTIVES

Literature demonstrates that colorectal cancer is nowadays one of the most common malignancies. Laparoscopy and robotic surgery are progressively gaining popularity in the treatment of colorectal tumors. Complete mesocolic excision and central vascular ligation have been widely adopted with encouraging results in terms of an improvement of overall survival, but some studies in the literature seem to demonstrate a higher morbidity rate.

METHODS

We conducted a retrospective study from 01/01/2010 to 30/04/2019 on a series of 250 patients, 155 males (62%) and 95 females (38%) who underwent right colectomy with minimally invasive approach, complete mesocolic excision, central vascular ligation, and intracorporeal anastomosis.

RESULTS

No perioperative mortality occurred. Postoperative morbidity rate was 6%, including 10 cases of anastomotic leak (5%). Conversion rate was 2.5%. Mean hospital stay was 6 days (range, 4-25 days). Mean operative time was 70 minutes (range, 50-130 minutes). No cases of duodenal or pancreatic damages, no chronic pain or diarrhea, and no severe alteration of bowel function were recorded. We observed only 3 cases of transient delayed gastric emptying.

CONCLUSIONS

Laparoscopic right colectomy with complete mesocolic excision, central vascular ligation and intracorporeal anastomosis leads to encouraging oncological mid- and long-term outcomes with low complications rates.

摘要

背景与目的

文献表明,结直肠癌是当今最常见的恶性肿瘤之一。腹腔镜手术和机器人手术在结直肠肿瘤治疗中的应用日益广泛。完整结肠系膜切除术和中央血管结扎术已被广泛采用,在提高总生存率方面取得了令人鼓舞的结果,但文献中的一些研究似乎显示出更高的发病率。

方法

我们对2010年1月1日至2019年4月30日期间的250例患者进行了一项回顾性研究,其中男性155例(62%),女性95例(38%),这些患者均接受了微创入路的右半结肠切除术、完整结肠系膜切除术、中央血管结扎术和体内吻合术。

结果

无围手术期死亡发生。术后发病率为6%,包括10例吻合口漏(5%)。中转开腹率为2.5%。平均住院时间为6天(范围4 - 25天)。平均手术时间为70分钟(范围50 - 130分钟)。未记录到十二指肠或胰腺损伤病例,无慢性疼痛或腹泻,也无肠道功能严重改变。仅观察到3例短暂性胃排空延迟。

结论

腹腔镜下完整结肠系膜切除、中央血管结扎和体内吻合的右半结肠切除术可带来令人鼓舞的中长期肿瘤学结果,且并发症发生率较低。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/4d06/7242021/53553266ed22/jls0201638430001.jpg

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