腹腔镜右半结肠癌根治术中保留胃网膜右静脉的临床研究

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目的:腹腔镜右半结肠癌根治手术的入路及手术步骤已程序化并达成专业共识,然而,一些细节问题如手术中Henle干的处理、术中是否保留胃网膜右静脉(RGEV)等仍然存在争议。为此,本研究探讨腹腔镜右半结肠癌根治术中保留RGEV的安全性、可行性以及近、远期临床疗效。方法:采用回顾性队列研究的方法,分析2016年3月至2018年5月期间,在江苏省泰州市人民医院胃肠外科接受腹腔镜右半结肠癌根治术的92例患者的临床资料。所有病例均行右半结肠完整结肠系膜切除术(CME),术后病理数据及随访资料完整。根据肿瘤具体位置决定术中是否保留RGEV,49例为保留RGEV组,43例为不保留RGEV组,分析比较两组患者术后一般情况、肿瘤安全性指标、术后并发症及近、远期疗效。结果:保留RGEV组与不保留RGEV组患者基线资料的比较,差异无统计学意义(均n P>0.05)。保留RGEV组与不保留RGEV组手术时间、术中出血量、非计划再手术、吻合口漏、清扫淋巴结数目、转移淋巴结数目、术后进食时间比较,差异均无统计学意义(均n P>0.05)。与不保留RGEV组相比,保留RGEV组术后缩短了肛门排气时间[(3.1±1.0)d比(4.0±1.7)d,n t=-2.787,n P=0.007]和住院时间[(11.5±1.5)d比(15.0±7.9)d,n t=-2.823,n P=0.007];降低了住院费用[(4.6±0.5)万元比(5.7±3.3)万元,n t=-2.076,n P=0.044]。不保留RGEV组围手术期胃瘫发生率14.0%(6/43),保留RGEV组无胃瘫病例发生(n P0.05). No significant differences were found in operation time, intraoperative blood loss, unplanned reoperation, anastomotic leak, number of harvested lymph nodes, number of metastatic lymph node, and time to food intake after surgery between two groups (alln P>0.05). Compared with non-preservation group, the preservation group had faster recovery of anal gas passage after operation [(3.1±1.0) days vs. (4.0±1.7) days,n t=-2.787, n P=0.007], shorter length of hospitalization [(11.5±1.5) days vs. (15.0±7.9) days, n t=-2.823, n P=0.007], and reduced the hospitalization expenses [(46 000±5000) yuan to (57 000±33 000) yuan, n t=-2.076, n P=0.044]. No postoperative gastroparesis (PGS) occurred in the preservation group, while 6 cases in the non-preservation group developed gastroparesis during perioperative period (n P<0.05). The median time of follow-up time was 31.8 (5.2-43.7) months. The overall survival time of the preservation group and non-preservation group was (35.4±1.8) months and (37.6±1.7) months, respectively without significant difference (n P=0.336); the disease-free survival was (32.0±2.2) months and (35.5±2.0) months, respectively without significant difference as well (n P=0.201).n Conclusions:Dissection of the Henle's truck and preservation of RGEV is safe and feasible during laparoscopic right hemicolectomy, which can significantly reduce the incidence of postoperative gastroparesis, shorten the recovery time of postoperative intestinal function and hospitalization, and decrease the cost of hospitalization. The efficacy of RGEV preservation is similar to non-preservation of RGEV.
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