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

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

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*

1.汕头大学医学院，广东汕头 515041； 2. 南方医科大学附属广东省人民医院（广东省医学科学院）胃肠外科，普通外科，广州 510080；　3. 广东省人民医院赣州医院（赣州市立医院）普外科，江西赣州 341000； 4. 河源市人民医院胃肠外科，广东河源 517000； 5. 广东省心血管病研究所，广州 510080

收稿日期:2024-02-29 出版日期:2024-07-25 发布日期:2024-08-23
作者简介:曾俊（1983-），男，广东五华人，副主任医师，硕士研究生，研究方向：胃肠外科，E-mail: ceng8585@163.com；并列第一作者：张越（1997-），男，广东汕头人，博士研究生，研究方向：胃肠外科，E-mail: dallas19970519@outlook.com；刘奇（1989-），男，湖南岳阳人，硕士研究生，研究方向：胃肠外科，E-mail: liuqi_0706@163.com
基金资助:
国家临床重点专科建设项目（2021-2024，No. 2022YW030009）；“广东特支计划”领军人才项目（2023-2026，No.0620220103）；广东省卫健委项目（2023-2025，B2023430）

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*

1. Shantou University Medical College, Shantou 515041, Guangdong Province, China; 2. Department of Gastrointestinal Surgery, Department of General Surgery, Guangdong Provincial People's Hospital (Guangdong Academic of Medical Science), Southern Medical University, Guangzhou 510080, Guangdong Province, China; 3. Department of General Surgery, Guangdong Provincial People's Hospital Ganzhou Hospital (Ganzhou Municipal Hospital), Ganzhou 341000, Jiangxi Province, China; 4. Department of Gastrointestinal Surgery, Heyuan People's Hospital, Heyuan 517000, Guangdong Province, China; 5. Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou 510080, Guangdong Province, China

Received:2024-02-29 Online:2024-07-25 Published:2024-08-23

摘要/Abstract

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。

关键词: 中横结肠癌； , , 单纯中横结肠癌根治术； , , 扩大结肠癌根治术； , , 临床预后

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.

Key words: Middle transverse colon cancer;　Simple radical resection of middle transverse colon cancer, 　Extended radical resection of transverse colon cancer;　Prognosis

中图分类号:

R656.9

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.

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.

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.

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

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

PDF (PC)

可视化

摘要/Abstract

引用本文

使用本文

参考文献

相关文章 15

Metrics

本文评价

推荐阅读 0

[1]	邹雨忻, 王瑞伟, 吴哲, 侯文静, 许杉杉, 樊汝涛, 王延洲, 吴毅. 基于MRI和解剖学测量的宫颈癌精准T分期诊断预测研究[J]. 中国临床解剖学杂志, 2024, 42(4): 382-392.
[2]	陈永正, 刘维, 周旭茹, 黎珂仰, 张功铭, 梁伟旭, 张钰瑞, 张子晴, 陈飞, 陈志国. 经颈内静脉进行中心静脉置管的解剖研究及临床意义[J]. 中国临床解剖学杂志, 2024, 42(4): 419-423.
[3]	张雁儒, 杨越, 董家琪, 徐景超, 韩道正, 苏甲子 . cAMP/PKA/CREB信号通路对卵巢早衰继发骨质疏松大鼠骨微结构影响研究[J]. 中国临床解剖学杂志, 2024, 42(4): 435-442.
[4]	刘燕, 李欣欣, 高晶, 李涛, 孙丽. 夫精人工授精早期妊娠丢失的影响因素分析[J]. 中国临床解剖学杂志, 2024, 42(4): 443-448.
[5]	张杨, 王鹏, 白明, 王俊峰, 李树文, 李志军, 吴一民 . 显微内窥镜下两种不同腰椎融合术的比较研究[J]. 中国临床解剖学杂志, 2024, 42(4): 453-456.
[6]	邹保利, 白文博, 张凯亭, 莫方东, 李卓, 沈国栋, 赖志斌, 朱永展. 距舟楔骨融合术治疗Müller-Weiss病：20例5年中期随访[J]. 中国临床解剖学杂志, 2024, 42(4): 457-462.
[7]	李骏然, 李冬梅, 翟婧秀, 杨海涛, 刘弘扬, 梁俊生, 李力更. 牵引床辅助直接前侧入路半髋关节置换术的并发症分析[J]. 中国临床解剖学杂志, 2024, 42(4): 468-471.
[8]	殷钦, 印飞, 顾珺, 王军, 林伟枫 . Krackow缝合法联合缝线桥技术治疗儿童髌骨下极骨折[J]. 中国临床解剖学杂志, 2024, 42(4): 472-474.
[9]	肖晨曦, 周浩瑞, 郑心彤, 章浩民, 赖嘉豪, 苏继东, 周坤, 孙诗竹, 付饶. 肩胛上动脉解剖变异类型及临床意义[J]. 中国临床解剖学杂志, 2024, 42(4): 475-479.
[10]	孔玥莹, 王艺霖, 赵宏, 谭思杰, 黄文华. 3D打印在脊髓损伤修复中的研究现状与展望[J]. 中国临床解剖学杂志, 2024, 42(4): 480-483.
[11]	江晨, 王纯, 黄永杰, 杨怡然, 胡文吴海鹰. MCU在神经系统中的研究进展[J]. 中国临床解剖学杂志, 2024, 42(4): 484-487.
[12]	李海艳, 刘英东, 宋东帅, 杨志鹏, 杜心如. 副神经和迷走神经、颈神经根交通支的形态学观察及临床意义[J]. 中国临床解剖学杂志, 2024, 42(3): 241-245.
[13]	孙克, 周广文, 蒋智烨, 王洪岗. 横突根部入路经皮椎弓根螺钉的解剖基础研究[J]. 中国临床解剖学杂志, 2024, 42(3): 246-250.
[14]	马仁财, 马向阳, 邹小宝, 付索超, 邓琛府, 陈钧麟, 陈泽星. 新型枢椎棘突椎板螺钉固定的影像解剖学测量研究[J]. 中国临床解剖学杂志, 2024, 42(3): 251-258.
[15]	赖文华, 毛隆昆, 王诗雨, 李奕宣, 刘瑞平, 徐达政, 李明哲, 周丽华. 华南地区国人成人腹腔干分型变异的临床应用研究[J]. 中国临床解剖学杂志, 2024, 42(3): 259-264.