腹腔镜扩大结肠癌根治术与单纯中横结肠癌根治术解剖学及临床意义

doi:10.13418/j.issn.1001-165x.2024.4.07

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中国临床解剖学杂志 ›› 2024, Vol. 42 ›› Issue (4) : 399-405. DOI: 10.13418/j.issn.1001-165x.2024.4.07

应用解剖

腹腔镜扩大结肠癌根治术与单纯中横结肠癌根治术解剖学及临床意义

曾俊^1,2,3#，　张越^2,3#，　刘奇^4#，　刘春生^2,3，　刘志远^1,2,3，　苏嘉睿^2,3，　吴嘉伟^2,3,5，　姚学清^3,2,1,4,5*

作者信息 +

Anatomy and clinical significance of laparoscopic extended radical resection and simple radical resection of transverse colon cancer

Zeng Jun^1,2,3#, Zhang Yue^2,3#, Liu Qi^4#, Liu Chunsheng^2,3, Liu Zhiyuan^1,2,3, Su Jiarui^2,3, Wu Jiawei^2,3,5, Yao Xueqing^3,2,1,4,5*

Author information +

文章历史 +

摘要

目的　探索中横结肠癌解剖学及生物学特性的关联，研究术式选择的差异与预后关系，确定最佳手术方式。方法　利用解剖学和影像学数据，研究大体标本、三维血管重建图，回顾性分析中横结肠癌患者不同腹腔镜手术方式的临床效果和生存情况。结果　(1)解剖并观察大体标本，发现一、二级血管结扎可确保结肠吻合口的血液供应；(2)术前三维血管重建与术中血管探查符合率大于90%；(3)横结肠切除组与扩大结肠切除组相比，术中出血量、手术时间、术后并发症、总生存率无统计学差异，两组淋巴结清扫数目有统计学差异。结论　腹腔镜下单纯横结肠切除较扩大结肠癌根治术有降低术后并发症风险趋势，两者预后无统计学差异，横结肠切除是中横结肠癌最佳手术方式。

Abstract

　Objective　To explore the relationship between anatomy and biological characteristics of middle transverse colon cancer, to study the relationship between the choice of operation and prognosis, and to determine the best mode of operation.　Methods　Using anatomical and imaging data, gross specimens and three-dimensional vascular reconstruction maps were studied, and the clinical effects and survival of patients with middle transverse colon cancer treated by different laparoscopic operations were analyzed retrospectively.　Results　(1)The primary and secondary vascular ligation can ensure the blood supply of the anastomotic colon; (2)The coincidence rate of preoperative three-dimensional vascular reconstruction and intraoperative vascular exploration was more than 90%; (3)There was no statistical difference in the intraoperative bleeding volume, operation time, postoperative complications and overall survival rate between the transverse colectomy group and the expanded colectomy group. There was significant difference in the number of lymph node dissection between the two groups.　Conclusions　Laparoscopic transverse colectomy alone has a tendency to reduce the risk of postoperative complications compared with extended radical resection of colon cancer, and there is no statistical difference in prognosis between them. Transverse colectomy is the best surgical method for middle transverse colon cancer.

导出引用

曾俊, 张越, 刘奇, 刘春生, 刘志远, 苏嘉睿, 吴嘉伟, 姚学清. 腹腔镜扩大结肠癌根治术与单纯中横结肠癌根治术解剖学及临床意义[J]. 中国临床解剖学杂志. 2024, 42(4): 399-405 https://doi.org/10.13418/j.issn.1001-165x.2024.4.07

Zeng Jun, Zhang Yue, Liu Qi, Liu Chunsheng, Liu Zhiyuan, Su Jiarui, Wu Jiawei, Yao Xueqing. Anatomy and clinical significance of laparoscopic extended radical resection and simple radical resection of transverse colon cancer[J]. Chinese Journal of Clinical Anatomy. 2024, 42(4): 399-405 https://doi.org/10.13418/j.issn.1001-165x.2024.4.07

中图分类号： R656.9

参考文献

[1] Wray CM, Ziogas A, Hinojosa MW, Le H, et al. Tumor subsite location within the colon is prognostic for survival after colon cancer diagnosis[J]. Dis Colon Rectum,2009, 52(8):1359-1366. DOI:10.1007/DCR. 0b013e3181a7b7de.
[2] Huang S, Wang X, Deng Y, et al. Gastrocolic ligament lymph node dissection for transverse colon and hepatic flexure colon cancer: risk of nodal metastases and complications in a large-volume center[J]. J Gastrointest Surg, 2020, 24(11):2658-2660. DOI:10.1007/s11605-020-04705-4.
[3] Wang X, Huang S, Lu X, et al. Incidence of and risk factors for gastroepiploic lymph node involvement in patients with cancer of the transverse colon including the hepatic flexure[J]. World J Surg, 2021, 45(5):1514-1525. DOI:10.1007/s00268-020-05933-0.
[4] Roy MK, Pipara A, Kumar A. Surgical management of adenocarcinoma of the transverse colon: What should be the extent of resection[J]? Ann Gastroenterol Surg, 2020, 5(1):24-31. DOI:10.1002/ags3.12380.
[5] Ueki T, Nagai S, Manabe T, et al. Vascular anatomy of the transverse mesocolon and bidirectional laparoscopic D3 lymph node dissection for patients with advanced transverse colon cancer[J]. Surg Endosc, 2019, 33(7):2257-2266. DOI:10.1007/s00464-018-6516-2.
[6] Zmora O, Bar-Dayan A, Khaikin M, et al. Laparoscopic colectomy for transverse colon carcinoma[J]. Tech Coloproctol, 2010, 14(1):25-30. DOI:10.1007/s10151-009-0551-x.
[7] Ogi Y, Egi H, Ishimaru K, et al. Cadaveric and CT angiography study of vessels around the transverse colon mesentery[J]. World J Surg Oncol, 2023, 21(1):36. DOI:10.1186/s12957-023-02919-9.
[8] 王枭杰,黄颖. 横结肠癌根治术应用膜解剖[J]. 中华结直肠疾病电子杂志,2022, (4):272-280. DOI:10.3877/cma.i.issn.2095-3224. 2022. 04.002.
[9] Balaban V, Ziyobekov H, Tsarkov P. The role of the accessory middle colic artery in D3 lymph node dissection for cancer of the splenic flexure-a video vignette[J]. Colorectal Dis, 2023, 25(2):330-331. DOI:10.1111/codi.16306.
[10] Japanese Society for Cancer of the Colon and Rectum. Japanese Classification of Colorectal, Appendiceal, and Anal Carcinoma: the 3d English Edition(Secondary Publication)[J]. J Anus Rectum Colon, 2019, 3(4):175-195. DOI:10.23922/jarc.2019-018.
[11] Fukuoka H, Fukunaga Y, Nagasaki T, et al. Lymph node mapping in transverse colon cancer treated using laparoscopic colectomy with D3 lymph node dissection[J]. Dis Colon Rectum, 2022, 65(3):340-352. DOI:10.1097/DCR.0000000000002108.
[12] Matsuda T, Sumi Y, Yamashita K, et al. Optimal surgery for Mid-Transverse colon cancer: laparoscopic extended right hemicolectomy versus laparoscopic transverse colectomy[J]. World J Surg, 2018, 42(10):3398-3404. DOI:10.1007/s00268-018-4612-z.
[13] Yamaoka Y, Kinugasa Y, Shiomi A, et al. The distribution of lymph node metastases and their size in colon cancer[J]. Langenbecks Arch Surg, 2017, 402(8):1213-1221. DOI:10.1007/s00423-017-1628-z.
[14] Palmisano S, Silvestri M, Troian M, et al. Ileocaecal valve syndrome after surgery in adult patients: myth or reality[J]? Colorectal Dis, 2017, 19(8):e288-e295. DOI:10.1111/codi.13778.
[15] 冯波, 钟昊, 张森, 等. 腹腔镜右半结肠癌根治术切除范围争议与共识[J]. 中国实用外科杂志, 2023, 43(10):1144-1146. DOI:10.19538/j.cjps. issn1005-2208. 2023.10.15.