伴血管变异的腹腔镜右半结肠癌根治术个体化手术入路的多学科临床探讨

目的:探讨中结肠动脉(middle colic artery,MCA)和回结肠静脉(ileocolic vein,ICV)血管变异及对腹腔镜右半结肠癌根治术手术入路选择的多学科协作体系(multidisciplinary treatment,MDT)的诊治流程。方法:分析2018年3月天津医科大学肿瘤医院收治1例MCA和ICV血管变异的右半结肠癌患者的MDT诊疗过程。患者经MDT讨论后接受有限中间入路腹腔镜右半结肠癌根治术。观察指标:1)手术和术后恢复情况;2)术后病理学检查情况;3)随访情况。结果:1)手术和术后恢复情况:患者顺利完成有限中间入路腹腔镜右半结肠癌根治术,无术中和术后并发症发生。术后住院时间为11 d。2)术后病理学检查情况:淋巴结清扫数目为39枚。病理学分期为pT3N0,病理学类型为中分化腺癌。3)随访情况:术后随访时间为10个月,无瘤生存。结论:个体化手术是结肠外科未来的发展趋势。采取MDT有利于制定规范化、个体化的手术方案,探索更安全和精准的手术入路,从而让更多患者获益。

Multidisciplinary treatment discussion of a personalized approach of laparoscopic right hemicolectomy for variant middle colic artery and ileocolic vein

  Objective  To investigate the variants of middle colic artery (MCA) and ileocolic vein (ICV) and their influence on the decision regarding approach of laparoscopic right hemicolectomy.  Methods  We analyzed the diagnosis and treatment of one right colon cancer patient with variant MCA and ICV who was admitted to the Tianjin Medical University Cancer Hospital in March 2018. The patient underwent laparoscopic right hemicolectomy via a limited medial approach after a multidisciplinary treatment (MDT) discussion. Following were the observation indicators: 1) surgical and postoperative recovery situations; 2) postoperative pathological examination; and 3) follow-up situation.  Results  1) Surgical and postoperative recovery situations: the patient successfully underwent laparoscopic right hemicolectomy via a limited medial approach. No intraoperative or postoperative complications occurred. Duration of postoperative hospital stay was 11 days. 2) Postoperative pathological examination: the number of dissected lymph nodes was 39. Postoperative pathological tumor stage was pT3N0. Postoperative pathological tumor type was moderately differentiated adenocarcinoma. 3) Follow-up situation: the patient was followed-up for 10 months with disease-free survival.  Conclusions  Individual and standard surgery will be the best choice for treating colon cancer patients. MDT can facilitate clinical decision-making and benefit patients.