作者：何耀明1，谭群英1， 梁伟俊1，王成兴1，李尚仁1，李晓平２，赵景林１

单位：１. 广东江门市中心医院（ 中山大学附属江门医院） 胃肠外科， 广东 江门 529000; ２. 广东江门市中心医院（ 中山大学附属江门医院） 乳腺外科， 广东 江门 529000

Authors:  He Yaomin, Tan Qunying, Liang Weijun, Wang Chengxing, Li Shangren, Li Xiaoping, Zhao Jinglin

Unit:  Department of Gastrointestinal Surgery, Jiangmen Central Hospital, Affiliated Jiangmen Hospital of Sun Yat-sen University, Jiangmen 529000, Guangdong, China

摘要：

目的 探讨改良横向入路法腹腔镜下游离结肠脾曲在乙状结肠癌、直肠癌根治术中应用的可行性及安全性。 方法 选取江门市中心医院2020年6月至2021年6月期间进行结肠脾曲松解的乙状结肠癌、直肠癌的病例101例,根据结肠脾曲松解方式的不同分为中间入路组52例,改良横向入路组49例,对比两组病例术中并发症(包括胰腺的损伤,横结肠系膜贯通损伤及脾脏损伤)的发生率,以及松解结肠脾曲耗费时间,术中出血量,清扫淋巴结数目,术后首次排气时间,术后血红蛋白下降程度,术后C反应蛋白数值,术后吻合口瘘的发生,术后住院天数、住院费用等指标。结果 改良横向入路组术中总并发症的发生率显著低于中间入路组(0比11.5%, P=0.042),游离结肠脾曲耗费时间更短[(24.61±3.74) min比(27.67±5.99)  min, P=0.003],两组术中出血量、清扫淋巴结数目、术后首次排气时间、术后C反应蛋白数值、术后吻合口瘘的发生、术后出院天数等差异均无统计学意义。结论 采用改良横向入路方法游离结肠脾曲,既能节省时间,又能减少术中并发症的发生。 

关键词：脾曲; 乙状结肠癌; 直肠癌; 腹腔镜

Abstract：

Objective To evaluate the security and feasibility of applying a modified transverse approach for splenic flexure mobilization (SFM) in laparoscopic radical resection of the sigmoid colon and rectal cancer. Methods We used the case retrospective analysis method. Patients enrolled in Jiangmen Central Hospital Gastrointestinal Surgery Department from Jun 2020 to Jun 2021 who were diagnosed with sigmoid colon cancer or rectal cancer undergo laparoscopic radical resection with SFM were analyzed. One hundred-one case met a criterion. 52 cases are medial approach group, and 49 cases were modified transverse approach group according to the manner of SFM, respectively. To find out which approach was better, we analyzed the followed items. They are intra-operation complications (including pancreas-injury, transverse mesocolon-penetrate, and spleen-injury), consuming time of SFM, intra-operation bleeding volume, number of harvested lymph nodes, first-time flatus, post-operation hemoglobin (HCB) decline, post-operation Creactive protein (CRP), anastomotic leakage rate, post-operation hospitalization days, and hospitalized cost. Results The modified transverse approach group exhibited a significantly lower rate in total complications [0vs.11.5%, P=0.042] and less time [(24.61+3.7) mins vs. (27.67+5.99) mins, P=0.003] of SFM compared with the medial approach. And there is no significant difference in intra-operation bleeding volume, the number of harvested lymph nodes, first-time flatus, post-operation C reactive protein, anastomotic leakage rate, post-operation hospitalization days, and occurrence of postoperative anastomotic leakage. Conclusions Applying the modified transverse approach in SFM during laparoscopic radical resection of the sigmoid colon and rectal cancer is timesaving, and more importantly, reduces intra-operation complications. It is worth promoting.

Key Words:  Splenic flexure; Sigmoid colon cancer; Rectal cancer; Laparoscopic