腹腔镜乙状结肠癌伴降结肠系膜旋转不良一例报道

降结肠系膜旋转不良（PDM）是由降结肠与腹膜后融合不全引起的,PDM通常无症状。然而,降结肠系膜旋转不良、乙状结肠向右侧与回盲部的先天粘连以及肠系膜下动脉的解剖变异等均可能会对结直肠癌的手术决策及难易度产生影响。我们报道一例乙状结肠癌伴肝转移瘤合并PDM的诊治,对其腹腔镜手术治疗的体会及注意要点加以阐述。     

Laparoscopic vs open extended right hemicolectomy for colon cancer

AIM:To evaluate the feasibility,safety,and oncologic outcomes of laparoscopic extended right hemicolectomy(LERH)for colon cancer.METHODS:Since its establishment in 2009,the Southern Chinese Laparoscopic Colorectal Surgical Study(SCLCSS)group has been dedicated to promoting patients’quality of life through minimally invasive surgery.The multicenter database was launched by combining existing datasets from members of the SCLCSS group.The study enrolled 220 consecutive patients who were recorded in the multicenter retrospective database and underwent either LERH(n=119)or open extended right hemicolectomy(OERH)(n=101)for colon cancer.Clinical characteristics,surgical outcomes,and oncologic outcomes were compared between the two groups.RESULTS:There were no significant differences in terms of age,gender,body mass index(BMI),history of previous abdominal surgery,tumor location,and tumor stage between the two groups.The blood loss was lower in the LERH group than in the OERH group[100(100-200)mL vs 150(100-200)mL,P<0.0001].The LERH group was associated with earlier first flatus(2.7±1.0 d vs 3.2±0.9 d,P<0.0001)and resumption of liquid diet(3.6±1.0 d vs 4.2±1.0 d,P<0.0001)compared to the OERH group.The postoperative hospital stay was significantly shorter in the LERH group(11.4±4.7 d vs 12.8±5.6 d,P=0.009)than in the OERH group.The complication rate was 11.8%and17.6%in the LERH and OERH groups,respectively(P=0.215).Both 3-year overall survival[LERH(92.0%)vs OERH(84.4%),P=0.209]and 3-year disease-free survival[LERH(84.6%)vs OERH(76.6%),P=0.191]were comparable between the two groups.CONCLUSION:LERH with D3 lymphadenectomy for colon cancer is a technically feasible and safe procedure,yielding comparable short-term oncologic outcomes to those of open surgery.     

Laparoscopic versus open right hemicolectomy with curative intent for colon carcinoma

AIM: Laparoscopic surgery, especially laparoscopic rectal surgery, for colorectal cancer has been developed considerably. However, due to relatively complicated anatomy and high requirements for surgery techniques, laparoscopic right colectomy develops relatively slowly. This study was designed to compare the outcomes of laparoscopic right hemicolectomy (LRH) with open right hemicolectomy (ORH) in the treatment of colon carcinoma. METHODS: Between September 2000 and February 2003, 30 patients with colon cancer who underwent LRH were compared with 34 controls treated by ORH in the same period. All patients were evaluated with respect to surgery related complications, postoperative recovery, recurrence and metastasis rate, cost-effectiveness and survival. RESULTS: Among 30 LRH, 2 (6.7%) were converted to open procedure. No significant differences were observed in terms of mean operation time, blood loss, post-operative complications, and hospital cost between LRH and ORH groups. Mean time for bowel movement, hospital stay, and time to resum?early activity in the LRH group were significantly shorter than those in the ORH group (2.24±0.56 vs 3.25±1.29 d, 13.94?.5 vs 18.25±5.96 d, 3.94±1.64 vs 5.45±1.82 d respectively, P<0.05). As to the lymph node yield, the specimen length and total cost for operation and drugs, there was no significant difference between the two groups. Local recurrence rate and metachronous metastasis rate had no marked difference between the two groups. Cumulative survival probability at 40 mo in LRH group (76.50%) was not obviously different compared to the ORH group (74.04%). CONCLUSION: LRH in patients with colon cancer has statistically and clinically significant advantages over ORH. Thus, LRH can be regarded as a safe and effective procedure.     

Laparoscopic hemicolectomy in a patient with situs inversus totalis

As among persons with normal anatomy, occasional patients with situs inversus develop malignant tumors. Recently, several laparoscopic operations have been reported in patients with situs inversus. We describe laparoscopic hemicolectomy with radical lymphadenectomy in such a patient. Careful consideration of the mirror-image anatomy permitted safe operation using techniques not otherwise differing from those in ordinary cases. Thus, curative laparoscopic surgery for colon cancer in the presence of situs inversus is feasible and safe.     

快速康复护理在腹腔镜结肠癌术后康复中的应用

目的探讨快速康复护理在腹腔镜结肠癌术后康复的应用价值。 方法招募2018年1月至2019年1月行全身麻醉腹腔镜下结肠癌手术的128例患者,完全随机分为快速康复护理组和常规护理组。统计手术时间、出血量、卧床时间、首次排气、排便时间、医疗费用、住院时间及术后疼痛等级、术后并发症发病率;分析两组间的差异。 结果两组间年龄、性别、手术时间、出血量等无明显差异(P>0.05)。快速康复组卧床时间、首次排气、排便时间少于常规护理组(P<0.05);快速康复组医疗费用、住院时间均少于对照组(P<0.05);快速康复护理组患者术后6 h、24 h、48 h疼痛程度均小于常规护理组患者(P<0.05);快速康复护理组术后不良反应及并发症发生率少于常规护理组。 结论快速康复护理可有效减低腹腔镜结肠癌术后并发症发生率,加速患者康复,减少住院时间,提高患者满意度。     

Five-year long-term outcomes of laparoscopic surgery for colon cancer

AIM:To perform a meta-analysis to answer whether long-term recurrence rates after laparoscopic-assisted surgery are comparable to those reported after open surgery.METHODS:A comprehensive literature search of the MEDLINE database,EMBASE database,and the Cochrane Central Register of Controlled Trials for the years 1991-2010 was performed.Prospective randomized clinical trials(RCTs)were eligible if they included patients with colon cancer treated by laparoscopic surgery vs open surgery and followed for more than five years.RESULTS:Three studies involving 2147 patients reported long-term outcomes based on five-year data and were included in the analysis.The overall mortality was similar in the two groups(24.9%,268/1075 in the laparoscopic group and 26.4%,283/1072 in open group).No significant differences between laparoscopic and open surgery were found in overall mortality during the follow-up period of these studies[OR(fixed) 0.92,95%confidence intervals(95%CI):0.76-1.12,P=0.41].No significant difference in the development of overall recurrence was found in colon cancer patients,when comparing laparoscopic and open surgery [2147 pts,19.3%vs 20.0%;OR(fixed)0.96,95% CI:0.78-1.19,P=0.71].CONCLUSION:This meta-analysis suggests that laparoscopic surgery was as efficacious and safe as open surgery for colon cancer,based on the five-year data of these included RCTs.     

Techniques and feasibility of laparoscopic extended right hemicolectomy with D3 lymphadenectomy

AIM:To illustrate the critical techniques and feasibility of laparoscopic extended right hemicolectomy(LERH),according to our previous experience.METHODS:Anatomical relationship and operative techniques were demonstrated.One hundred and five consecutive patients who underwent extended right hemicolectomy with D3 lymphadenectomy between January 2008 and May 2011 were included in the present study[laparoscopic group(n=48)vs open group(n=57)].RESULTS:The right retrocolic space was the main surgical plan of the LERH.The superior mesenteric vein was the most important anatomical landmark for vascular dissection.The medial-to-lateral dissection approach made the LERH performed efficiently.Compared with the open group,the LERH group had less blood loss(111.7±127.8 mL vs 170.2±49.7 mL,P=0.023),faster return of flatus(3.0±1.6 d vs 3.7±1.3 d,P=0.019),and earlier diet(4.2±1.4 d vs 5.0±1.2 d,P=0.005).Five patients(10.4%)underwent conversion during laparoscopic surgery.The cancer recurrence rates between the two groups were comparable(laparoscopic vs open,8.6%vs 9.1%,P=0.335).CONCLUSION:For an advanced tumor located at the hepatic flexure or proximal transverse colon,LERH with D3 lymphadenectomy using a medial-to-lateral approach seems to be safe and feasible when the superior mesenteric vein serves as the main anatomical landmark and the right retrocolic space severed as the surgical plan.     

Single port laparoscopic right hemicolectomy with D3 dissection for advanced colon cancer

We report the first case of single port laparoscopic right hemicolectomy for advanced colon cancer.An abdominal 3 cm length incision was made via the umbilicus.A small wound retractor and a surgical glove were used as a single port.All soft tissue anterior to the superior mesenteric vein was completely removed and D3 lymph node dissection was achieved.The total operative time was 180 min with minimal blood loss (&lt;50 mL).The size of the tumor was 5 cm&#215;3 cm and its tumor stage was T3N0.Sixty-nine lymph nodes ...     

A case of ascending colon variceal bleeding treated with venous coil embolization

A 38-year-old female with a history of alcoholic liver cirrhosis visited our hospital with a massive hematochezia.An esophagogastroduodenoscopy did not demonstrate any bleeding source,and a colonoscopy showed a massive hemorrhage in the ascending colon but without an obvious focus.The source of the bleeding could not be found with a mesenteric artery angiography.We performed an enhanced abdominal computed tomography,which revealed a distal ascending colonic varix,and assumed that the varix was the source of the bleeding.We performed a venous coil embolization and histoacryl injection to obliterate the colon varix.The intervention appeared to be successful because the vital signs and hemoglobin laboratory data remained stable and because the hematochezia was no longer observed.We report here on a rare case of colonic variceal bleeding that was treated with venous coil embolization.     

Concurrent laparoscopic right hemicolectomy and ultra-low anterior resection with colonic J-pouch anal anastomosis for synchronous carcinoma

An extensive large bowel resection with a single anastomosis is the accustomed management option for widely spaced synchronous colorectal neoplasms. We report a successful case of concurrent laparoscopic right hemicolectomy and ultra-low anterior resection with colonic J-pouch anal anastomosis in an 85-year-old man with synchronous cancers of the hepatic flexure and lowrectum. This surgical technique is advantageous for elderly patients as it provides the benefits of multiple segmental resection and laparoscopic surgery while potentially reducing mortality, time of procedure, postoperative pain, ileus, length of hospitalization and direct cost of care, and improving independence at discharge. The technique for efficient multiple extractions of specimens and effective reconstitution of pneumoperitoneum for a multistaged procedure is discussed.     

Standardized Laparoscopic Intracorporeal Right Colectomy for Cancer: Short-Term Outcome in 111 Unselected Patients

Purpose  This study was designed to evaluate the impact of a standardized laparoscopic intracorporeal right colectomy on the short-term outcome of patients with neoplasia. Methods  Consecutive patients with histologically proven right colon neoplasia underwent a standardized laparoscopic intracorporeal right colectomy with medial to lateral approach encompassing ten sequential steps: 1) ligation of ileocolic vessels, 2) identification of right ureter, 3) dissection along superior mesenteric vein, 4) division of omentum, 5) division of right branch of middle colic vessels, 6) transection of transverse colon, 7) mobilization of right colon, 8) transection of terminal ileum, 9) ileocolic anastomosis, 10) delivery of specimen. Values were medians (ranges). Results  From July 2002 to June 2005, 111 laparoscopic intracorporeal right colectomies were attempted with a 5.4 percent conversion rate. There were 57 women and 54 men, aged 64.9 (range, 40–85) years, with body mass index of 33 (range, 20–43), American Society of Anesthesiology score of 2 (range, 2–4), 36.9 percent comorbidities, and 37.8 percent previous abdominal surgery. The indication for surgery was cancer in 109 patients. Operative time was 120 (range, 80–185) minutes. Estimated blood loss was 69 (range, 50–600) ml. Overall length of skin incisions was 66 (range, 60–66) mm; 29 (range, 2–41) lymph nodes were harvested. Length of stay was four (range, 2–30) days. Complication rate was 4.5 percent. Conclusions  A standardized laparoscopic intracorporeal right colectomy resulted in a favorable short-term outcome in unselected patients with neoplasia of the right colon. Poster presentation at the meeting of the American College of Surgeons, Chicago, Illinois, October 8 to 12, 2006.     

腹腔镜下往复式右半结肠D3/CME根治术

目的随着腹腔镜右半结肠D3/CME根治手术逐渐成为发展趋势,为更好克服D3根治术SMV前方淋巴结清扫的困境,本文介绍一种易于操作的往复式推进术式。 方法该新手术方式具有下列2个特点：自尾侧向头侧多次往复式分离并以胰腺颈部下缘为终点,先于左侧缘显露SMV全长再处理静脉属支。回顾2012~2015年采用本方法的58例患者术中术后指标,评估其安全性及可行性。 结果2例患者因腹腔粘连中转,余58例患者均顺利完成手术,手术时间164±28.3 min,出血量64±63.5 ml,清扫淋巴结数目28±13.9个,术后无严重并发症及围手术期死亡。 结论腹腔镜下往复式右半结肠D3/CME根治术时简单、安全且可行的,为解决SMV静脉属支变异带来的手术困难提供了更安全的新的手术入路方式。     

晚期结肠癌转化治疗后行右半结肠切除一例

对于晚期结肠癌患者,根治性的手术治疗是其获得治愈的唯一手段,本例患者为全身晚期（cT4bN2M1a）,经过外院转化治疗后病情未获缓解,并出现肠梗阻症状,经我院MDT综合评估后,行右半结肠切除术。     

Metastatic right atrial tumor in colon cancer with superior vena cava syndrome and tricuspid obstruction

Summary Metastatic colon carcinoma of the heart is a rare diagnosis, and an uncommon finding at autopsy. This report describes a patient with a huge intracavitary colonic metastasis of the right atrium causing both a superior vena cava syndrome and an obstruction of the tricuspid valve. To our knowledge, no similar case has been previously reported.     

Laparoscopic Medial-to-Lateral Approach for the Curative Left Hemicolectomy

INTRODUCTION Laparcoscopic curative left hemicolectomy requires the takedown of colonic splenic flexure and has been challenging. The present study aims to examine if the technical advantages of medial-to-lateral dissection method, as shown in our previous laparoscopic rectosigmoid resection, can be extrapolated to the laparoscopic left hemicolectomy. METHODS A total of 24 consecutive patients (from October 2004 to March 2005) with left-sided colon cancer requiring the takedown of colonic splenic flexure to facilitate a curative left hemicolectomy were subjected to this laparoscopic procedure that included initial incision on the mesentery medial to inferior mesenteric vein, ligation of vessels in no-touch isolation fashion, subsequent medial-to-lateral extension of retroperitoneal dissection along Gerota fascia, opening of lesser sac by transection of gastrocolic ligament, dissection of mesenteric root of distal transverse colon, and the final separation of splenocolic ligament and lateral attachments of descending colon. The technical efficiency, the number of cleared lymph node, and functional recovery of patients were prospectively evaluated. RESULTS The laparoscopic medial-to-lateral approach is considered as highly efficient because it was preformed with acceptable operation time (214.4 ± 54.4 minutes, mean±standard deviation) and little blood loss (40.0 ± 14.0 ml) through a small wound (5.5 ± 0.6 cm). The number of dissected lymph nodes was 14.0 ± 3.0. There were no major complications. Moderate morbidity represented 8 percent of all cases, including minor leakage in 1 case (4 percent) and wound infection in 1 case (4 percent). The patients have quick functional recovery, as evaluated by the length of postoperative ileus (48.0 ± 12.0 hours), hospitalization (9.0 ± 1.0 days), and degree of postoperative pain (3.5 ± 0.5, visual analog scale). The overall costs were NT$194,000.0 ± 3200.0 (1.0 US dollar = 32.0 NT$). CONCLUSION By medial-to-lateral dissection method, the laparoscopic takedown of colonic splenic flexure can be performed with highly technical efficiency, acceptable number of cleared lymph node, and short convalescence. We therefore recommend this dissection method to the expert surgeons, endeavoring to define a standard technique to curative surgery in the left-sided colon cancers, and especially to the beginners, seeking to shorten their learning curve of laparoscopic left hemicolectomy. This multimedia article (video) has been published online and is available for viewing at. Its abstract is presented here. As a subscriber to Diseases of the Colon & Rectum you have access to our SpringerLink electronic service, including Online First. This work was supported by grants from NTU 94S040, National Taiwan University Hospital, Tapei, Taiwan.     

A giant ascending aortic aneurysm associated with a ruptured sinus of valsalva into the right atrium: Role of multimodality imaging

A giant ascending aortic aneurysm associated with a ruptured sinus of Valsalva is rare. A 53-year-old male patient successfully underwent Bentall procedure after multimodality imaging which enable the correct diagnosis to be established and intraoperative transesophageal echocardiography provides additional information on the surgical planning.     

Laparoscopic and robot-assisted gastrectomy for gastric cancer: Current considerations

R a d i c a l g a s t r e c t o m y w i t h a n a d e q u a t e l y m p h-adenectomy is the main procedure which makes it possible to cure patients with resectable gastric cancer(GC). A number of randomized controlled trials and meta-analysis provide phase Ⅲ evidence that laparoscopic gastrectomy is technically safe and that it yields better short-term outcomes than conventional open gastrectomy for early-stage GC. While laparoscopic gastrectomy has become standard therapy for early-stage GC, especially in Asian countries such as Japan and South Korea, the use of minimally invasive techniques is still controversial for the treatment of more advanced tumours, principally due to existing concerns about its oncological adequacy and capacity to carry out an adequately extended lymphadenectomy. Some intrinsic drawbacks of the conventional laparoscopic technique have prevented the worldwide spread of laparoscopic gastrectomyfor cancer and, despite technological advances in recent year, it remains a technically challenging procedure. The introduction of robotic surgery over the last ten years has implied a notable mutation of certain minimally invasive procedures, making it possible to overcome some limitations of the traditional laparoscopic technique. Robot-assisted gastric resection with D2 lymph node dissection has been shown to be safe and feasible in prospective and retrospective studies. However, to date there are no high quality comparative studies investigating the advantages of a robotic approach to GC over traditional laparoscopic and open gastrectomy. On the basis of the literature review here presented, robot-assisted surgery seems to fulfill oncologic criteria for D2 dissection and has a comparable oncologic outcome to traditional laparoscopic and open procedure. Robot-assisted gastrectomy was associated with the trend toward a shorter hospital stay with a comparable morbidity of conventional laparoscopic and open gastrectomy, but randomized clinical trials and longer follow-ups are needed to evaluate the possible influence of robot gastrectomy on GC patient survival.     

Laparoscopic Total Mesorectal Excision for Rectal Cancers

Introduction More and more colorectal surgeons believe that total mesorectal excision can achieve favorable oncologic results for the treatment of rectal cancers. The present study is a feasibility study aiming to evaluate if total mesorectal excision can be safely performed by laparoscopic approach with beneficial functional recovery. Methods A total of 44 patients (from January 2004 to February 2005) with middle rectal cancer (the average distance from anal verge was 7.8 cm, ranging from 5.0 to 10.0 cm) without preoperative chemoradiation therapy were selected to undergo laparoscopic total mesorectal excision. Before the study entry, all patients underwent pelvic magnetic resonance imaging or multislice spiral computed tomography to evaluate the circumferential resection margin of rectal cancer. Only patients whose circumferential resection margin was not involved by rectal cancer were considered as potentially curable by total mesorectal excision procedures and were enrolled for this study. The operation procedures were conducted according to the guidelines advocated by Heald et al.1 and were shown in the video. Posteriorly, the dissection was along the ‘holy plane’ downward to the level of levator ani muscle. Anteriorly, the dissection plane was at the anterior part of Denonvilliers fascia. Laterally, the lateral ligaments were sharply cauterized at the medial part. The resected bowel was reconstructed with stapled end-to-end anastomosis. The surgical outcomes of this procedure were prospectively evaluated. Results The laparoscopic total mesorectal excision was performed with acceptable operation time (234.4±44.4 minutes, mean±standard deviation) and little blood loss (80.0±24.0 ml) through a small wound (5.0±0.5 cm). Histopathology showed that all patients were able to get adequate distal section margins (mean: 2.8 cm; range: 1.6–5.4 cm) and negative circumferential resection margins (mean: 8.4mm; range: 2–14 mm). The number of dissected lymph nodes was 16.0±4.0. The pathologic tumor–node–metastasis stages were as follows: Stage I: n= 4; Stage II: n = 22; Stage III: n = 18. Two patients (4.5 percent) were diverted by protective ileostomy. There was no mortality within 30 days after operation. However, anastomotic leakage occurred in 3 patients. The patients have quick functional recovery, as evaluated by the length of postoperative ileus (48.0±12.0 hours), hospitalization (9.0±1.0 days) and degree of postoperative pain (3.5±0.5, visual analog scale). Besides the expenses covered by the National Bureau of Health Insurance in Taiwan, the patient had to pay an extra expense of NT$ 65000.08000.0 (1.0US dollars = 32.0 NT$). During the follow-up periods (median: 14 months, range. 2 to 27 months), three patients of Stage III and 1 patient of Stage II developed a recurrent disease (lung metastasis: n = 2; liver metastasis: n = 1, and pelvic recurrence, n = 1). Conclusion By laparoscopic approach, the total mesorectal excision for rectal cancers can be safely performed with good functional recovery. However, with only a median follow-up of 14 months in this case series, the long-term oncologic outcomes for these patients remain a question. Further randomized prospective study is thus mandatory to provide solid evidence of this approach. This multimedia article (video) has been published online and is available for viewing at . Its abstract is presented here. As a subscriber to Diseases of the Colon & Rectum you have access to our SpringerLink electronic service, including Online First. Video presentation in Yonsei Colorectal Cancer International Symposium, Seoul, South Korea, May 28, 2005. Grant support from 94S040, National Taiwan University Hospital. Reprints are not available.     

Pancreatic or duodenal resection or both for advanced carcinoma of the right colon

PURPOSE: The role of extended resections for locally advanced carcinomas of the right colon infiltrating duodenum and pancreas remains unclear. This investigation was undertaken to review our experience with pancreatic head or duodenal resections for advanced right-sided colon cancer. METHODS: The clinical, pathologic, and follow-up details of eight patients with bulky primary carcinomas of the right colon infiltrating the duodenum (n=4) or pancreatic head (n=4) surgically managed at Memorial Sloan-Kettering Cancer Center between 1986 and 1998 were reviewed. RESULTS: Six patients presented with anemia, and one patient each with epigastric pain and an abdominal mass. All patients had T4 lesions, whereas five had lymph node metastases at presentation. All patients were resected with clear pathologic margins either by right colectomy anden bloc duodenectomy (n=4), oren bloc pancreaticoduodenectomy (n=4). The 30-day mortality rate was zero. Six patients remained alive and free of disease at a median follow-up of 26 months, and there was one long-term survivor who was alive and free of disease at 84 months after resection. CONCLUSION: Extended resection for localized primary colonic carcinoma invading pancreas or duodenum can be undertaken safely and is associated with prolonged survival time.Dr. Koea is supported by the Eru Pomare Fellowship from the Health Research Council of New Zealand.