腹腔手术史结肠癌患者腹腔镜辅助D3根治术效果及手术技巧

目的探讨腹腔镜辅助D3根治术治疗多次手术右半结肠癌患者的术中技巧、注意事项及术后近期并发症分析。 方法回顾分析2013年1月至2015年12月26例有多次腹腔手术史的右半结肠癌患者施行腹腔镜辅助D3根治术的临床资料。其中肿瘤位于回盲部7例，位于升结肠15例，位于结肠肝曲4例；术前病理证实腺癌；术前行阑尾切除8例，行开腹胆囊切除4例，行腹腔镜胆囊切除术(LC)3例，同时行阑尾切除及胆囊切除3例，行腹腔镜胃窦部切除术1例，行剖宫产5例，行右侧附件手术(宫外孕及右侧附件囊肿切除)2例。 结果全部手术均在腹腔镜辅助下顺利完成，无中转开腹，无手术死亡病例；结肠癌切除包括肿块在内的右半结肠及部分回肠；术后病理证实所有标本残端均无肿瘤细胞残留、浸润。手术时间150～325 min，平均186 min；术中出血量100～300 ml，平均180 ml；术后肠蠕动恢复时间36～120 h，平均72 h；淋巴结清扫8～21枚，平均15.6枚。术后无出血、吻合口狭窄及瘘等并发症发生，术后1例切口感染；1例术后反复出现粘连性肠梗阻，经过保守治疗后痊愈。术后住院9～28 d，平均18.2 d；术后电话随访至2016年3月，有肝转移1例，有局部复发1例，再发肠梗阻行复发肿瘤切除，回肠造瘘；其他患者随访期内均未发现转移、复发及切口种植。 结论腹腔镜辅助D3根治术对于有腹腔手术史的结肠癌患者安全有效；具有创伤小、出血少优点，但术中操作要求更精细，术后并发症相对无腹腔手术史患者较多，但仍取得与传统开腹手术媲美的治疗效果。

Operative techniques and complication of laparoscopy-assisted radical right hemicolectomy with D3 lymphadenectomy for colon cancer of abdominal operations

ObjectiveTo analyze operative technique and complication of laparoscopy-assisted right hemicolectomy with D3 lymphadenectomy for colon cancer of many abdominal operations. MethodsThe clinical data of 26 cases underwent laparoscopy-assisted radical right hemicolectomy with D3 lymphadenectomy for colon cancer between Jan. 2013 and Dec. 2015 in our department were collected, among them, 8 cases performed appendectomy, 4 cases by cholectomy, 3 cases by laproscopic cholectomy, 3cases by appendectomy and cholectomy; 1case by laproscopic antrectomy; 5 cases by cesarean; 2 cases by right adenex operation.the safety of operation, status of recovery, complication, oncological outcomes, and results of short-/long-term follow-up were analyzed. ResultsNo case died and converted to open surgery.Colon cancer was resected including tumors and about 25-30 cm intestine. Postoperative pathological examination revealed no residual or infiltration of tumor cells in stump.The operation time was 150-325 min(mean, 186 min), and the intraoperative blood loss was 100-300 ml(mean, 180 ml). The postoperative convalescence of intestinal peristalsis was 36-120 hours(mean, 72 hours).8-21 lymph nodes were resected(mean, 15.6); There were no operative complications such as hemorrhage, anastomotic stenosis.Infection of incision wound of perineal region occurred in 1 case, adhesive intestine obstruction in 1 case.The post-operative hospital stay was 9-28 days, with an average of 18.2 days.After surgery, telephone followed up to Mar. 2016, one case had intestine obstruction and tested local recurrence and other has liver metastasis. other patients in the follow-up period, no metastasis, recurrence or incision implantation were found. ConclusionsLaparoscopy-assisted radical right hemicolectomy with D3 lymphadenectomy for colon cancer of many abdominal operations is not only technologically feasible and safe with less trauma, pain and complication, but also completely effective comparing to the open colectomy and more complications comparing to no adominal operation patients.