摘要目的 探讨腹腔镜下按D3淋巴结清扫和完整结肠系膜切除实施根治性右半结肠切除术的可行性.方法 回顾性分析按前述原则实施的经腹腔镜根治性右半结肠切除术患者的临床资料,记录手术时间、出血量、淋巴结获取数目、并发症和中转开腹率等资料;比较性别、年龄、美国麻醉师协会(ASA)评分、体重指数、T分期、N分期和TNM分期等临床病理特点与3年无病生存率和总生存率之间的关系.结果 共入组111例患者,其中男性50例,女性61例.患者平均手术时间(168±42) min,术中平均出血量(81±63) ml,淋巴结获取数目(30±12)枚,中转开腹率1.8％.没有术后30 d内死亡病例,3年无病生存率和总生存率分别为86.5％和93.7％.总并发症发生率17.1％,包括腹泻(菌群紊乱)(7例)、泌尿系统感染(3例)、肠梗阻(3例)、伤口裂开(2例)等.随着T分期进展,患者无病生存率和总生存率呈逐步下降趋势,但差异未达到统计学意义;TNM Ⅰ、Ⅱ期患者的无病生存率明显优于Ⅲ期患者(x2=6.985,P=0.030);N0、N1期患者的无病生存率(x2=14.397,P=0.001)和总生存率(x2=16.699,P=0.000)均优于N2期患者.结论 在腹腔镜下按D3淋巴结清扫和完整结肠系膜切除实施根治性右半结肠切除术是安全、可行的,并能取得令人满意的肿瘤学疗效.

abstractsObjective To investigate the feasibility of laparoscopic approach for totally mesocolic resection and D3 lymphadenectomy in right colectomy.Methods A retrospective study was conducted to analyze the operating time,blood loss,lymph node retrieval,postoperative complications and converting rate.The relationships of 3-year disease-free survival (DFS),3-year overall survival (OS) to gender,age,American Society of Anesthesiologists (ASA) score,body mass index (BMI),T-staging,N-staging and TNM classification were also analyzed by Kaplan-Meier surviving curve and Log-rank test.Results A total of 111 patients were enrolled in present study.There were 50 male and 61 female patients.The average operating time was (168 ± 42) minutes,blood loss was (81 ± 63) ml,lymph node retrieval was (30 ± 12).The converting rate to open surgery was 1.8％.There was no death within 30 days after operation.The 3-year DFS and 3-year OS was 86.5％ and 93.7％ respectively.The short-term complications occurred in 17.1％ of the patients,including diarrhea (7 cases),ileus (3 cases),urinary infection (3 cases),wound dehiscence (2 cases) and so on.With the T staging progress,DFS and OS in patients showed a gradual decline,but the difference did not reach statistical significance (P ＞ 0.05).TNM classification had relation to DFS (x2 =6.985,P =0.030),while N-staging showed significant relations both to DFS and OS (x2 =14.397 P =0.001 ;x2=16.699,P =0.000).Conclusion Laparascopic approach to right hemicolectomy with complete mesocolic resection and D3 lymphadenectomy is safe and has satisfied oncological outcome.