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中华腔镜外科杂志(电子版)

中华腔镜外科杂志(电子版) ›› 2017, Vol. 10 ›› Issue (04): 214 -217. doi: 10.3877/cma.j.issn.1674-6899.2017.04.007

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腹腔镜右半结肠切除术中内侧到外侧清扫方法提供优异的淋巴结数量
王峰 1 , †( ), 龚旭晨 1   
  1. 1. 830001 乌鲁木齐，新疆维吾尔自治区人民医院肛肠外科
  • 收稿日期:2017-04-21 出版日期:2017-08-30
  • 通信作者: 王峰

A medial to lateral approach offers a superior lymph node harvest for laparoscopic right colectomy

Feng Wang 1 , †( ), Xuchen Gong 1   

  1. 1. Anorectal Surgery, Autonomous Region People′s Hospital, Urumqi 830001, China
  • Received:2017-04-21 Published:2017-08-30
  • Corresponding author: Feng Wang
  • About author:
    Corresponding author: Wang Feng, Email:
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目的

评估两种腹腔镜技术进行右侧结肠切除术，腹腔镜内侧到外侧(MtL)方法和腹腔镜外侧到内侧(LtM)方法在接受内镜不能切除的息肉或肿瘤的右侧结肠切除术患者中的最佳的淋巴结收获术式。

方法

收集在5年内进行腹腔镜右侧结肠切除术的患者。对人口统计学、外科手术方法、住院时间和收获的淋巴结数量进行了评估。对两种方法间的变量进行统计学分析和结果比较。

结果

本研究233例患者中，70例接受了腺瘤切除术，予以排除；163例接受了癌切除，有55例患者接受了MtL治疗(MtL组)，108例患者接受了LtM治疗(LtM组)。当比较两组时，MtL组相对于LtM组有更多女性(78% vs 66%; P＝ 0.001 5)。当比较收获淋巴结数量时，与LtM方法(平均＝ 19; P＝ 0.000 2)相比，在MtL方法(平均＝24)收获的淋巴结数量明显较多。MtL组和LtM组之间的住院时间相似(两组均为4 d)。

结论

与腹腔镜LtM方法相比，腹腔镜右侧结肠切除术MtL方法获得较多的淋巴结数量。

关键词: 内侧切除术, 升结肠癌, 收获淋巴结
Objective

To evaluate two laparoscopic techniques to right colectomy, laparoscopic medial to lateral (MtL) approach and laparoscopic lateral to medial (LtM) approach, in patients undergoing a right colectomy for either endoscopically unresectable polyps or carcinoma and determine which technique offers the optimal lymph node harvest.

Methods

Patients that underwent a laparoscopic right colectomy over a 5-year period were identified. Charts were reviewed with regards to demographics, surgical approach, length of stay and number of lymph nodes harvested.Variables were statistically analyzed and outcomes compared between the two groups.

Results

Two hundred thirty-three patients underwent a laparoscopic right colectomy 163 cases over a 5-year period for endoscopically unresectable polyps or carcinoma, 70 cases of adenoma, did not do lymph node dissection to be excluded. 55 patients(MtL group) underwent a MtL approachand 108 patients(LtM group) underwent a LtM approach. When comparing the two groups, there were more females in the MtL group relative to the LtM group (78% vs 66%; P=0.001 5). When the outcome of number of lymph nodes harvested was examined, there was a significantly larger number of nodes harvested in the MtL (median=24) approach compared to the LtM approach (median=19; P=0.000 2). Length of stay was similar between the MtL and LtM group (median 4 days for both).

Conclusions

The laparoscopic MtL approach to right colectomy yields a larger lymph node harvest compared to the laparoscopic LtM approach.

Key words: Medial disection, Ascending colon cancer, Nodal harvest
表1 腹腔镜右半结肠切除术患者的两组T期、N期分布情况比较[例(%)]
组别 例数 T期 N期
T1 T2 T3 T4 N0 N1 N2
LtM组 108 21(19.4) 23(21.3) 44(40.7) 20(18.5) 72(66.7) 26(24.1) 10(9.3)
MtL组 55 11(20.0) 13(23.6) 27(49.1) 4(7.3) 33(60.0) 19(34.5) 3(5.4)
P值 ? 1.00 0.84 0.32 0.06 0.49 0.19 0.54
表2 腹腔镜右半结肠切除术患者的两组结果比较
组别 例数 平均住院时间(d) 获得的淋巴结数(枚) 平均阳性淋巴结数(枚) 阳性淋巴结比率(%)
LtM组 108 4 19 0.72 0.19
MtL组 55 4 24 0.86 0.13
P值 ? < 0.000 1 0.000 2 0.67 0.16
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