3D腹腔镜在右半结肠癌全结肠系膜切除术中的应用

目的探讨3D腹腔镜下全结肠系膜切除术(CME)治疗右半结肠癌的可行性及安全性。方法回顾分析2014年1月至2016年9月在我科接受3D腹腔镜全结肠系膜切除术的18例右半结肠癌患者的临床资料,选取同期接受2D腹腔镜CME术的23例患者的相关资料,比两组在手术持续时间、术中出血量、淋巴结清扫数目、术后标本质量、住院时间、费用以及术后并发症等方面的差异。结果 3D腹腔镜组手术时间217.8±35.9 min、清扫淋巴结数目25.0±4.9枚,与2D腹腔镜组223.2±40.0 min、24.0±5.7枚比较,差异无统计学意义(P0.05)。3D腹腔镜组术中出血量96.8±24.2 mL与2D腹腔镜组124.2±43.7 mL比较,差异具有统计学意义(P0.05)。手术质量分级方面,两组均无West A级病例;3D腹腔镜组West C级17例,West B级1例;2D腹腔镜组West C级14例;West B级9例,差异具有显著性(P0.05)。3D腹腔镜组首次排气时间3.4±0.7 d、平均住院时间13.5±2.3 d、平均住院费5.2±0.7万元,与2D腹腔镜组3.3±0.8 d、12.9±2.3 d、5.4±0.9万元相比,差异无统计学意义(P0.05)。3D腹腔镜组术后并发症2例,2D腹腔镜组术后并发症4例,差异无统计学意义(P0.05)。结论 3D腹腔镜下全结肠系膜切除术治疗右半结肠癌安全可行。

Application of three-dimensional laparoscopic complete mesocolic excision for right hemi-colon cancer

【Abstract】 Objective To investigate the clinical value of three?dimensional（3D）laparoscopic complete mesocolic excision for right hemi?colon cancer. Methods The clinical and pathological data of 41 patients with advanced distal gastric cancer，who received treatment in our hospital of from January 2014 to September 2016，were analyzed retrospectively. Among these cases, 18 patients received 3D laparoscopic CME and 23 patients for 2D laparoscopic CME. The clinical effect was compared between the patients undergoing 3D laparoscopic CME and 2D laparoscopic CME. Results No significant difference was found in the average operation time and lymph node dissected（3D，217.8±35.9 vs 2D，223.2±40.0） min，（25.0±4.9 vs 24.0±5.7）between the two groups. The intraoperative blood loss in 3D group were less than that in the 2D group（96.8±24.2 ml vs 124.2±43.7 ml），and the surgical operation quality in 3D group were better than that in the 2D group（P<0.05）. No significant differences were found in the anal exsufflation time，hospital stay，hospitalization cost，and postoperative complications between the two groups（P>0.05）. The hospital stay was 13.5±2.3 d in 3D group and 12.9±2.3 d in 2D group. The hospitalization cost were 5.2± 0.7 and 5.4±0.9 thousand Yuan in the two groups respectively. There was two patient with postoperative complications in 3D group，and four patients with postoperative complications in 2D group. Conclusions 3D laparoscopic complete mesocolic excision for right hemi?colon cancer is feasible and safe.