手辅助腹腔镜扩大右半结肠切除术应用体会

目的探讨手辅助腹腔镜行右半结肠扩大切除的临床应用价值。 方法回顾性分析2009年1月至2012年1月期间，21例施行手辅助腹腔镜手术扩大切除的右半结肠癌患者的临床手术资料。 结果21例右半结肠癌患者中，20例成功施行右半结肠扩大切除术，1例中转开腹行姑息性右半结肠切除术。手助腹腔镜平均手术时间(146±23)min，平均术中出血量(92±59)ml，平均检出淋巴结25.3枚，术后肛门排气时间(44.3±6.2)h。术后并发症发生率为19%(4/21)，其中肺部感染1例，切口感染1例，淋巴瘘2例，无围手术期死亡患者。全组患者术后随访6～29个月，存活19例，1例死于腹膜转移，1例死于肝脏转移。 结论手助腹腔镜右半结肠癌扩大根治术技术安全可行，远期效果有待进一步观察。

Application of hand-assisted laparoscopic extended right hemicolectomy in patients with right colon carcinoma

ObjectiveTo evaluate the safety and feasibility effects of hand-assisted laparoscopic extended right hemicolectomy for right colon cancer. MethodsHand-assisted laparoscopic extended right hemicolectomy was performed on 21 patients from January 2009 to January 2012, and the clinical data of those patients was analyzed retrospectively. ResultsAmong the 21 patients, 20 cases received radical right hemicolectomy, 1 cases transferred to open palliative surgery.The mean operating time was (146±23)min, mean intraoperative blood loss was (92±59)ml, mean number of lymphnodes dissected was 25.3, the mean time of anal aerofluxus was (44.3±6.2)h.There was no perioperative death, and the postoperative complications occurred in 4 of 21 cases (19%), including pulmonary infection in 1 patient, incision infection in 1 patient and lymphatic fistulas in 2 cases. After follow-up from 6 to 29 months, 2 patients died of peritoneal and liver metastasis respectively, the other 19 cases were still alive. ConclusionsExtended right hemicolectomy can be perfectly performed by hand assisted laparoscopic surgery.The long-term results need further evaluation.