Caudal-to-cranial Approach for Laparoscopic Right Hemicolectomy - MMH Experience

腹腔鏡右側大腸切除手術－馬偕醫院經驗

韓昇宏(Shen-Hung Han) ； 孫文俊(Wen-Chun Sun) ； 陳雨農(Yu-Nung Chen) ； 賴正大(Cheng-Ta Lai) ； 蔡柏立(Po-Li Tsai) ； 楊靖國(Ching-Kuo Yang) ； 梁偉雄(Wai-Hung Leung) ； 劉建國(Chien-Kuo Liu) ； 陳明仁(Ming-Jen Chen) ； 許希賢(Hsi-Hsien Hsu) ； 陳建勳(Jian-Syun Chen)

《中華民國大腸直腸外科醫學會雜誌》 29卷1期 (2018/03) Pp. 29-34

https://doi.org/10.6312/SCRSTW.2018.29(1).10622

摘要

Purpose. The lateral-to-medial approach is typically used in open surgery of right hemicolectomy. Laparoscopic right hemicolectomy is performed in medial-to-lateral approach conventionally and it is challenging for inexperienced surgeons. This study evaluated the outcomes of laparoscopic right hemicolectomy involving the lateral-to-medial and caudal-to-cranial approaches. Materials and Methods. From April 2016 to October 2016, 16 patients underwent laparoscopic right hemicolectomy with radical lymph node dissection in the lateral-to-medial and caudal-to-cranial approach for cecal, ascending colonic and proximal transverse colonic lesions. We retrospectively analyzed the data obtained from the Mackey Memorial Hospital database. Results. In this study, 9 male and 7 female patients were examined. The mean patient age was 63.4 years (37-89 years), and the mean operating time was 164 minutes (99-260 minutes). Furthermore, the mean blood loss was 56 ml, and the mean number of harvested lymph nodes was 23.8. The mean hospital stay was 7.5 days. No case was converted to open surgery. Post-operative morbidity occurred in 5 patients, including acute exacerbation of chronic obstructive pulmonary disease, urinary tract infection and wound infection. No post-operative mortality was reported within 30 days after surgery. Conclusions. Our results reveal the safety and feasibility of the caudal-to- cranial approach in laparoscopic right hemicolectomy, particularly for inexperienced surgeons. This technique provides more precise access to adequate dissection plane, protection of retroperitoneal organs, dissection of lymph node along the superior mesenteric vein and ligation of the middle colic vessels at the root.

關鍵字

Caudal-to-cranial approach ； Laparoscopic right hemicolectomy

並列摘要

目的：傳統開腹手術進行右側結腸切除與淋巴廓清手術，作法為由身體外側面至內側面進行廓清手術，而腹腔鏡手術的作法則相反，由內側面至外側面進行廓清手術，對於年輕醫師而言，使用腹腔鏡進行右側大腸手術一直是個挑戰。本研究在分析腹腔鏡右側大腸切除手術使用外側面到內側面進行淋巴廓清手術的安全性與可行性。方法：自2016年4月至2016年10月，腹腔鏡右側大腸切除與淋巴廓清手術，我們採用由身體外側面至內側面之作法進行廓清手術，總共16位病患接受手術以治療右側大腸腫瘤。我們統計及比較病人年齡、手術時間、失血量、廓清淋巴結數、平均住院天數以及是否產生術後併發症。所有病人資料皆從馬偕醫院資料庫取得並使用回溯式分析進行研究。結果：在我們的研究中，共有9位男性病人及7位女性病人。其平均年齡為63.4歲(37-89歲)。而平均手術時間為164分鐘(99-260分鐘)。平均失血量為56毫升。平均廓清淋巴結數量為23.8顆。平均住院天數為7.5天。無術中轉為傳統開腹手術之病人。這16位病人中有5位病人發生術後併發症，為慢性阻塞肺病變急性發作、泌尿道感染以及傷口感染，但並無手術後30天內死亡之個案。結論：關於年輕醫師進行腹腔鏡右側大腸切除與淋巴廓清手術，運用由身體外側面至內側面進行廓清手術是安全與可行的。此作法運用如同傳統剖腹手術的方式進行腹腔鏡淋巴結廓清手術。優點為較容易精準完整切除大腸腸繫膜、降低誤傷後腹腔器官之機率以及達到最佳淋巴結廓清率。

並列關鍵字

腹腔鏡右側大腸切除手術

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