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目的探讨对结肠肝曲癌行经腹腔镜幽门下淋巴结清扫的可行性及必要性。方法回顾性分析笔者所在医院科室2013年1月至2016年11月期间27例行腹腔镜下经中间入路的扩大右半结肠癌D3根治术患者的临床资料。结果 27例患者均行腹腔镜下经中间入路的扩大右半结肠癌D3根治术,无中转开腹。术后发生切口感染2例,炎性肠梗阻1例,肺部感染1例,无吻合口漏及吻合口出血发生。每例标本切取的淋巴结数目为12~31枚,平均19.3枚/例;伴淋巴结转移20例,淋巴结转移率为74.1%;共清扫淋巴结521枚,发生转移淋巴结191枚,淋巴结转移度为36.7%;全部标本中共切除幽门下淋巴结78枚,发生转移25枚,幽门下淋巴结转移度为32.1%。结论把握好适应证,选择合适的患者,结肠肝曲癌行腹腔镜下扩大右半结肠癌D3根治术,幽门下淋巴结清扫是有必要的,也是切实可行的。
Objective To investigate the feasibility and necessity of laparoscopic pyloric lymph node dissection of colorectal cancer. Methods Retrospective analysis of the clinical data of 27 patients undergoing laparoscopic approach to expand the right colon cancer with D3 in our hospital department from January 2013 to November 2016 was retrospectively analyzed. Results All of the 27 patients underwent laparoscopic radical dilatation of the right colon cancer by midline approach without radical surgery. Postoperative incision infection in 2 cases, 1 case of inflammatory intestinal obstruction, pulmonary infection in 1 case, no anastomotic leakage and anastomotic bleeding occurred. The number of lymph nodes removed from each specimen ranged from 12 to 31, with an average of 19.3 cases / case; with lymph node metastasis in 20 cases, the rate of lymph node metastasis was 74.1%; a total of 521 lymph nodes were dissected, 191 metastatic lymph nodes were found, the degree of lymph node metastasis was 36.7% In all the specimens, 78 pyloric lymph nodes were resected, 25 were metastasized, and the degree of pyloric lymph node metastasis was 32.1%. Conclusions Grasp the indications, select the right patients, colon cancer of the liver line laparoscopic right colon cancer D3 radical surgery, pyloric lymph node dissection is necessary and feasible.