机器人与腹腔镜右半结肠切除术近期疗效对照研究

目的 对比机器人与腹腔镜手术治疗右半结肠癌的近期疗效,评估机器人右半结肠切除术的安全性及可行性。方法 回顾性分析2014 年12 月至2016 年5月南昌大学第一附属医院普外科收治的行右半结肠切除术的60例右半结肠癌病人的临床资料,其中30例行机器人右半结肠切除术（RA组）,30例行腹腔镜右半结肠切除术（LA组）。比较两组病人术中情况及术后疗效。结果 与LA组比较,RA组术中出血少［（87.3±26.1）mL vs. （132.2±31.6）mL,P<0.05］,淋巴结清扫数目多［（15.6±4.5）枚 vs. （12.5±2.9）枚,P=0.036］,手术时间长［（152.3±12.4）min vs.（125.7±29.0）min,P=0.012］,首次排气时间缩短［（61.5±9.4）h vs. （69.7±10.5）h,P=0.042］,术后疼痛轻,住院总费用高［（52235.7±528.2）元 vs. （41263.5±436.1）元,P<0.05］,差异具有统计学意义。结论 机器人右半结肠癌切除术安全可行,且与腹腔镜手术相比,其对病人损伤更小,淋巴结清扫更彻底。     

腹腔镜右半结肠切除术的手术入路及注意事项

结直肠癌是成人最常见的消化道恶性肿瘤,发病率居我国恶性肿瘤的第三位,其发病率和死亡率逐年升高且呈年轻化的趋势.右半结肠癌约占结直肠癌中的41％,其5 年生存率低于左半结肠癌及直肠癌,如何提高病人的预后成为关注焦点[1].近年来尽管化疗、放疗及基因靶向治疗等不断发展,但右半结肠切除术仍是非转移性右半结肠癌的主要治疗手段....     

腹腔镜辅助右半结肠切除术16例临床分析

为探讨腹腔镜辅助右半结肠切除术的安全性和疗效,对16例行腹腔镜辅助右半结肠癌切除手术患者的临床资料进行回顾性分析。结果显示,顺利完成腹腔镜辅助右半结肠癌根治术14例,中转开腹2例,中转率为12．5％。无死亡病例。平均手术时间为（175±15）min,平均术中出血量为（120±9）ml,平均结肠癌切除标本上下切缘长度分别为（10．8±0．8）cm和（10．2±0．7）cm,平均清除淋巴结（16．1±1．2）枚,平均术后住院时间为（10±1）d。1例术后第3天肺部感染,1例切口感染。14例完成腹腔镜手术患者随访6～20个月,1例发生肝转移。结果表明,腹腔镜辅助右半结肠切除术安全性好,可达到与开腹手术同样的根治效果。     

手辅助腹腔镜与开腹右半结肠切除术疗效比较

目的比较手辅助腹腔镜与开腹右半结肠切除术的治疗效果。方法选取48例接受右半结肠切除术的结肠癌患者,根据不同术式分为2组,各24例。观察组实施手辅助腹腔镜手术,对照组行开腹手术。回顾性分析、比较2组的治疗效果。结果 2组的手术时间及淋巴结清除扫数比较,差异无统计学意义(P0.05)。观察组的术中出血量、术后排气时间、并发症发生率及住院时间均少于对照组,差异有统计学意义(P0.05)。结论手辅助腹腔镜与开腹右半结肠切除术近期均可获得满意效果,但前者具有出血少、恢复快、并发症少等优势,可酌情予以选择。     

腹腔镜辅助右半结肠切除术21例报告

目的探讨腹腔镜辅助右半结肠切除术治疗右侧结肠癌的安全性与疗效。方法应用腹腔镜技术,按开腹手术的原则行右半结肠切除术21例,所有肠系膜分离、肠系膜血管的处理和淋巴结清扫均在腹腔镜下完成,肠段的切除和吻合通过腹部小切口在体外完成。结果21例均成功完成手术,无中转开腹。手术时间136~248min,平均153.6min。结肠癌切除标本上下切缘长度分别(10.8±3.6)cm和(10.2±3.5)cm,清扫淋巴结数目(9.7±4.9)枚。1例术后切口感染,3个月后再次清创愈合。17例术后随访3~36个月,平均19个月。2例分别于术后8、20个月发生肝转移。无切口和穿刺口种植转移发生。结论腹腔镜辅助右半结肠切除术是安全可行的,按肿瘤根治原则可以达到开腹手术同样的疗效。     

比较开腹与腹腔镜右半结肠全结肠系膜切除术的效果

目的比较开腹与腹腔镜右半结肠全结肠系膜切除术(CME)的效果。方法依据不同手术方法将接受右半结肠CME术的80例患者分为2组,各40例。对照组行开腹手术,观察组行腹腔镜手术。回顾性分析患者的临床资料。结果 2组手术时间、术中出血量、术后排气时间、住院时间以及并发症发生率,差异均无统计学意义(P>0.05)。但观察组的淋巴结清扫数显著多于对照组,差异有统计学意义(P<0.05)。结论与开腹手术比较,腹腔镜右半结肠CME术更有利于保证淋巴结的清扫数目。     

单孔腹腔镜右半结肠切除术31例临床分析

目的：探讨单孔腹腔镜右半结肠切除术治疗结肠癌的临床疗效。方法回顾性分析2014年1月－2014年6月期间在我院行单孔腹腔镜治疗的31例升结肠癌患者的完整临床资料作为研究对象,研究该治疗方法的安全性与有效性。结果31例患者未出现1例术中死亡,其中26例患者单孔腹腔镜手术顺利完成,其余5例（16．13％）进行中转开腹。手术时间为（118．4±52．7）min,手术过程中患者出血量为（104．7±79．2）ml。术后腹水及感染各1例,特殊治疗后均好转出院。结论采用单孔腹腔镜右半结肠切除术治疗结肠癌是一种有效的治疗方案,具有损伤小、术后康复快等一系列优势,值得推广。     

达芬奇机器人手术系统辅助和腹腔镜辅助全结肠系膜切除术治疗右半结肠癌的疗效分析

目的:探讨达芬奇机器人手术系统辅助和腹腔镜辅助全结肠系膜切除术（CME）治疗右半结肠癌的临床疗效。方法:采用倾向评分匹配及回顾性队列研究方法。收集2016年7月至2019年7月陆军特色医学中心大坪医院收治的119例右半结肠癌病人的临床病理资料;男63例,女56例;年龄为（61±11）岁。119例病人均行右半结肠CME,...     

右侧结肠癌腹腔镜与传统开腹右半结肠切除术疗效分析

目的比较腹腔镜与传统开腹右半结肠切除术治疗右侧结肠癌的效果。方法随机将86例接受右半结肠切除手术的右侧结肠癌患者分为2组,各43例。对照组行开腹手术,观察组实施腹腔镜手术。比较2组的治疗效果。结果 2组手术时间、淋巴结清扫数、并发症发生率,差异无统计学意义(P0.05)。观察组术中出血量、术后肛门恢复排气时间及住院时间均少于或短于对照组,差异有统计学意义(P0.05)。2组患者术后2 a内的复发率和存活率,差异无统计学意义(P0.05)。结论与开腹右半结肠切除术比较,腹腔镜手术术中出血量少、患者术后恢复快、远期效果满意。而且在保证淋巴结清扫数目的同时,未显著增加手术时间和并发症发生率。     

腹腔镜辅助右半结肠切除术根治结肠癌

目的:探讨腹腔镜右半结肠切除术治疗结肠癌的安全性与有效性。方法:对2000年9月至2003年10月我科为41例右半结肠癌病人所行的腹腔镜右半结肠切除术进行随访,以研究其手术安全性、术后恢复情况及肿瘤的根治性效果。结果:无术中严重并发症和手术死亡病例,2例(4.9%)中转开腹手术;手术时间为(152.65±28.29)min、术中出血平均(112.94±96.36)ml。病人排气时间、下床时间、住院天数分别为(2.24±0.56)、(3.94±1.64)、(13.94±6.5)d。清扫淋巴结总数(11.24±8.02)枚[结肠上旁淋巴结(6.82±4.72)枚,系膜间淋巴结(2.59±2.43)枚,血管根部淋巴结(1.82±2.53)枚],手术切除标本长度(20.88±5.28)cm;除2例肺部感染、1例术后肠梗阻外余病人未见术后并发症;所有病人均获随访(12～46)个月,平均(29.15±7.95)个月,2例(4.9%)局部复发,3例(7.3%)发生肝转移,短期(46个月)累计生存率为74.50%。结论:腹腔镜右半结肠切除术治疗右半结肠癌是安全有效的,符合肿瘤根治原则。     

Open versus laparoscopic right hemicolectomy in the elderly population

AIM:To compare short term outcomes of elective laparoscopic and open right hemicolectomy(RH) in an elderly population.METHODS:All patients over the age of 70 undergoing elective RH at Ninewells Hospital and Perth Royal Infirmary between January 2006 and May 2011 were included in our analysis.Operative details,hospital length of stay,morbidity and mortality was collected by way of proforma from a dedicated prospective database.An extracorporeal anastomosis was performed routinely in the laparoscopic group.The primary endpoints for analysis were morbidity and mortality.Our secondary endpoints were operative duration,length of hospital stay and discharge destination.RESULTS:Two hundred and six patients were included in our analysis.One hundred and twenty-five patients underwent an open resection and 81 patients had a laparoscopic resection.The mean operating time was significantly longer in the laparoscopic group(139 ± 36 min vs 197 ± 53 min,P = 0.001).The mean length of hospital stay was similar in both groups(11.2 ± 7.8 d vs 9.6 ± 10.7 d,P = 0.28).The incidence of postoperative morbidities was 27% in the open group and 38% in the laparoscopic group(P = 0.12).Overall inhospital mortality was 0.8% in open procedures vs 1% in laparoscopic.CONCLUSION:Laparoscopic RH was associated with a significantly longer operative time compared to open RH.In our study,laparoscopic RH was not associated with reduced post-operative morbidity or significantly shorter length of hospital stay.     

Technique and survival after laparoscopically assisted right hemicolectomy

Background The role of laparoscopic colon resection in the management of colon cancer is still controversial. In this article, the surgical strategy and techniques are described, with further consideration of the oncologically relevant aspects.Methods Between March 1993 and July 2003, we performed laparoscopic right hemicolectomy in 56 patients with right colon carcinoma. Average age was 74.5 years (range, 17–92). We performed a standardized surgical procedure that included mobilization from the vascularized mesenteric bridges with a window technique, transection of the ileocolic lymphovascular pedicle, and lateral and proximal mobilization of the ileocecum, ascending colon, right flexure, and proximale transversum. After enlargement of one of the trocar incisions the exteriorized colon was resected and an extracorporeal anastomosis was performed in the standard manner.Results There were no conversions to open. The mean operating time was 119 ± 38 min, the mean length of resected colon was 27.8 ± 4.48 cm, and the average width of the clear margins was 6.8 ± 5.3 cm. One patient died. Lymph nodes were positive in 21 patients. The 5-year survival rate in the 48 patients who were operated on with curative intent was 75%. We have had two local recurrences. The overall 5-year mortality-free fraction was 63%. Cox multivariate analysis showed that the mortality-prognostic factors were tumor stage and length of resected colon, whereas Kaplan-Meier analysis showed that the mortality-prognostic factors were positive lymph nodes and tumor stage.Conclusions Our results show that laparoscopic right hemicolectomy for colon cancer can be performed safely. Complications and recurrence rates are comparable to those for left-sided laparoscopic and open procedures. Therefore, we recommend this procedure as the method of choice. Laparoscopically treated patients with stage II and stage III disease have almost the same cumulative rate of survival.     

Clinical outcome of laparoscopic and open colectomy for right colonic carcinoma

INTRODUCTION

Laparoscopic colorectal surgery has gained widespread acceptance. While many studies have compared laparoscopic and open left-sided resections, there is limited literature on right colonic resections. We aimed to analyse the short-term outcome of laparoscopic (LRH) and open right hemicolectomy (ORH) in our unit.

METHODS

Consecutive patients undergoing elective right hemicolectomies over a period of 28 months were included in the study. No selection criteria were used to allocate the surgical approach. Study parameters included surgical technique, demographic details, ASA grade, body mass index (BMI), length of hospital stay (LOS), post-operative mortality and morbidity, readmission rate and histopathological data.

RESULTS

A total of 164 patients underwent right hemicolectomies during the study period (LRH: 89, ORH: 75). Both groups were comparable in age, sex, BMI, ASA grade, tumour stage and lymph node harvest. Four patients (4.5%) in the laparoscopic group required conversion to open surgery. In resections with curative intent, microscopic margins were positive in two patients (3%) in the ORH group compared to one (1%) in the LRH group. Seven ORH patients had an adverse post-operative outcome (three anastomotic leaks, four deaths); there were no deaths/immediate complications in the LRH group (p<0.05). The median LOS for LRH patients (4 days, range: 2–21 days) was significantly shorter than for ORH patients (8 days, range: 3–38 days) (p<0.0001, Mann–Whitney U test). By day 5, 77% of LRH patients were discharged compared with only 21% of patients in the ORH group. There were two readmissions (2.7%) in the ORH group and nine (10.1%) in the LRH group.

CONCLUSIONS

Our findings demonstrate advantages in favour of LRH in terms of a shorter hospital stay and reduced post-operative major complications. LRH is safe and should therefore be available to all patients requiring colonic resection.     

3D和2D腹腔镜右半结肠癌根治术的比较与优势

随着微创理念的普及,腹腔镜手术已成为右半结肠癌根治切除的标准术式。传统的2D腹腔镜手术虽然仍是目前的主流,但随着技术进步,3D腹腔镜手术的发展同样迅猛。相比传统的2D腹腔镜,其最大的特点在于三维立体视觉效果,使得手术的操作更精细,定位更准确。在右半结肠手术中无论是在解剖层面的拓展,Henle干的处理,淋巴结清扫还是消化道重建方面都有一定的优势。由于3D腹腔镜良好的纵深感和距离感,使得初学者能更快的适应镜下的手眼配合,增加术中操作的稳定性和精确性,减少错误操作,缩短腹腔镜右半结肠癌根治术的学习曲线。     

腹腔镜右半结肠切除术外科间隙的解剖学观察

目的探讨腹腔镜右半结肠切除术（LRC）相关筋膜和间隙的局部解剖学特点。方法对7具尸体和49例接受LRC的患者进行解剖学观察：比较腹部健康者和结肠癌患者的CT影像资料。结果在升结肠系膜和肾前筋膜之间存在各向交通的右结肠后间隙：其前、后、中线侧、外侧、头侧和尾侧边界分别为升结肠系膜、各向延续的肾前筋膜、肠系膜上静脉、右结肠旁沟腹膜反折、十二指肠水平部下缘和肠系膜根下缘。在横结肠系膜和胰十二指肠之间．存在横结肠后间隙．其头侧以横结肠系膜根为界。在横结肠系膜和大网膜之间,存在胃结肠系膜间间隙。在CT影像上。正常肾前筋膜是与腹横筋膜相延续的等密度细线,右结肠后间隙无法辨认;但对于右侧结肠癌患者,肾前筋膜和右结肠后间隙可能受侵犯而较易辨认。结论右结肠后间隙和横结肠后间隙对于LRC是天然外科间隙．‘肾前筋膜是天然外科平面。     

腹腔镜与开腹右半结肠切除术根治结肠癌围手术期比较

目的:探讨腹腔镜右半结肠切除术的可行性及近期疗效。方法:回顾分析2004年5月至2009年2月行腹腔镜右半结肠癌根治术22例及开腹右半结肠癌根治术17例患者的临床资料,比较两组患者手术及术后情况。结果:腹腔镜组与开腹组手术时间分别为(199.55±32.3)min、(144.71±28.97)min,差异无统计学意义(P=0.099);切口长度分别为(5.55±0.74)cm、(19.24±2.67)cm,差异有统计学意义(P=0.00);出血量分别为(53.41±43.08)ml、(138.24±65.02)ml,差异有统计学意义(P=0.024);淋巴结清除数分别为(12.73±2.16)枚、(13.12±2.55)枚,差异无统计学意义(P=0.41);术后胃肠道功能恢复时间分别为(23.18±7.79)h、(64.18±13.07)h,差异有统计学意义(P=0.02)。结论:腹腔镜右半结肠癌根治术安全可行,具有患者创伤小,术后康复快的优点,根治效果可达到开腹手术的水平。     

全腹腔镜根治性右半结肠切除术

术中切开回结肠血管蒂下缘系膜进入正确层面,处理回结肠血管并清扫203组淋巴结;继续扩展右结肠后间隙,处理右结肠血管并清扫213组淋巴结,处理中结肠血管并清扫223组淋巴结;裁剪右侧半大网膜及横结肠系膜,游离结肠肝曲,向下游离整个右半结肠;全腔镜下行回肠横结肠侧侧吻合,标本装袋后取出。