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目的:介绍改良中线入路并左手控制技术在右半结肠癌完整结肠系膜切除中的应用体会。方法:回顾性分析河南省肿瘤医院普外科同一治疗组在2009年10月至2012年10月86例采用改良中线入路并左手控制技术行右半结肠癌完整结肠系膜手术患者临床资料,对手术时间、术中出血量、淋巴结清扫个数、术后排气时间、住院时间等指标进行统计。结果:本组无手术死亡病例;手术时间41.6~75.3(46.7±6.3)min;术中出血量30~100(36.8±9.6)mL;淋巴结清扫数12~18(14.4±2.4)枚/例;术后排气时间2~6(3.0±1.2)d;住院时间12~23(12.5±2.4)d;手术并发症6例(7%),胃瘫1例,乳糜漏3例,切口感染2例,分别给予促胃肠减压、鼻肠管营养支持治疗、留置腹腔引流管及切口换药后等保守治疗后痊愈出院。结论:在CME理念的基础上采用改良中线入路并运用左手控制技术,有效缩短手术时间,提高手术的安全性,保证手术的根治性;同时降低术中副损伤、术后谵妄及肺部感染的发生率;该术式可操作性强,易于推广。
Objective: To introduce the application of modified midline approach and left-handed control technique in the right colon cancer with complete mesorectal excision. Methods: The clinical data of 86 patients with right colon cancer treated by modified central line approach and left-handed control technique in the same treatment group of Henan Provincial Tumor Hospital from October 2009 to October 2012 were analyzed retrospectively. Time, intraoperative blood loss, the number of lymph node dissection, postoperative exhaust time, hospital stay and other indicators of statistics. Results: There was no operative death in this group. The operative time was 41.6-75.3 (46.7 ± 6.3) min, the intraoperative blood loss was 30-100 (36.8 ± 9.6) mL, the number of lymph node dissection was 12-18 (14.4 ± 2.4) The postoperative discharge time was 2 to 6 (3.0 ± 1.2) d, and the length of stay was 12 to 23 (12.5 ± 2.4) days. There were 6 cases (7%) of surgical complications, 1 case of gastric paralysis, 3 cases of chorioisis, Cases were given to promote gastrointestinal decompression, nasogastric nutrition support treatment, indwelling peritoneal drainage tube and incision dressing and other conservative treatment after discharge. Conclusion: Based on the concept of CME, the improved midline approach and the left-handed control technique are used to shorten the operation time, improve the safety of operation and ensure the radical operation. At the same time, it can reduce the intraoperative side injury, postoperative delirium and pulmonary infection The incidence of this procedure is operable and easy to promote.