伴血管变异的腹腔镜右半结肠癌根治术个体化手术入路的多学科临床探讨
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摘要
目的:探讨中结肠动脉(middlecolicartery,MCA)和回结肠静脉(ileocolicvein,ICV)血管变异及对腹腔镜右半结肠癌根治术手术入路选择的多学科协作体系(multidisciplinarytreatment,MDT)的诊治流程。方法:分析2018年3月天津医科大学肿瘤医院收治1例MCA和ICV血管变异的右半结肠癌患者的MDT诊疗过程。患者经MDT讨论后接受有限中间入路腹腔镜右半结肠癌根治术。观察指标:1)手术和术后恢复情况;2)术后病理学检查情况;3)随访情况。结果:1)手术和术后恢复情况:患者顺利完成有限中间入路腹腔镜右半结肠癌根治术,无术中和术后并发症发生。术后住院时间为11d。2)术后病理学检查情况:淋巴结清扫数目为39枚。病理学分期为p T3N0,病理学类型为中分化腺癌。3)随访情况:术后随访时间为10个月,无瘤生存。结论:个体化手术是结肠外科未来的发展趋势。采取MDT有利于制定规范化、个体化的手术方案,探索更安全和精准的手术入路,从而让更多患者获益。
Objective: To investigate the variants of middle colic artery(MCA) and ileocolic vein(ICV) and their influence on the decision regarding approach of laparoscopic right hemicolectomy. Methods: We analyzed the diagnosis and treatment of one right colon cancer patient with variant MCA and ICV who was admitted to the Tianjin Medical University Cancer Hospital in March 2018. The patient underwent laparoscopic right hemicolectomy via a limited medial approach after a multidisciplinary treatment(MDT) discussion.Following were the observation indicators: 1) surgical and postoperative recovery situations; 2) postoperative pathological examination; and 3) follow-up situation. Results: 1) Surgical and postoperative recovery situations: the patient successfully underwent laparoscopic right hemicolectomy via a limited medial approach. No intraoperative or postoperative complications occurred. Duration of postoperative hospital stay was 11 days. 2) Postoperative pathological examination: the number of dissected lymph nodes was 39.Postoperative pathological tumor stage was pT3 N0. Postoperative pathological tumor type was moderately differentiated adenocarcinoma. 3) Follow-up situation: the patient was followed-up for 10 months with disease-free survival. Conclusions: Individual and standard surgery will be the best choice for treating colon cancer patients. MDT can facilitate clinical decision-making and benefit patients.
Objective: To investigate the variants of middle colic artery(MCA) and ileocolic vein(ICV) and their influence on the decision regarding approach of laparoscopic right hemicolectomy. Methods: We analyzed the diagnosis and treatment of one right colon cancer patient with variant MCA and ICV who was admitted to the Tianjin Medical University Cancer Hospital in March 2018. The patient underwent laparoscopic right hemicolectomy via a limited medial approach after a multidisciplinary treatment(MDT) discussion.Following were the observation indicators: 1) surgical and postoperative recovery situations; 2) postoperative pathological examination; and 3) follow-up situation. Results: 1) Surgical and postoperative recovery situations: the patient successfully underwent laparoscopic right hemicolectomy via a limited medial approach. No intraoperative or postoperative complications occurred. Duration of postoperative hospital stay was 11 days. 2) Postoperative pathological examination: the number of dissected lymph nodes was 39.Postoperative pathological tumor stage was pT3 N0. Postoperative pathological tumor type was moderately differentiated adenocarcinoma. 3) Follow-up situation: the patient was followed-up for 10 months with disease-free survival. Conclusions: Individual and standard surgery will be the best choice for treating colon cancer patients. MDT can facilitate clinical decision-making and benefit patients.
引文
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[8]Jayne DG,Thorpe HC,Copeland J,et al.Five-year follow-up of the Medical Research Council CLASICC trial of laparoscopically assisted versus open surgery for colorectal cancer[J].Br J Surg,2010,97(11):1638-1645.
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[10]Negoi I,Beuran M,Hostiuc S,et al.Surgical anatomy of the superior mesenteric vessels related to colon and pancreatic surgery:A systematic review and meta-analysis[J].Scientific Reports,2018,8(1):4184.
[11]Stefura T,Kacprzyk A,Dro?J,et al.The venous trunk of henle(gastrocolic trunk):A systematic review and meta-analysis of its prevalence,dimensions,and tributary variations[J].Clin Anat,2018,31(8):1109-1121.
[12]Ogino T,Takemasa I,Horitsugi G,et al.Preoperative evaluation of venous anatomy in laparoscopic complete mesocolic excision for right colon cancer[J].Ann Surg Oncol,2014,21(3):429-435.
[13]Kuzu MA,Ismail E,Celik S,et al.Variations in the vascular anatomy of the right colon and implications for right-sided colon surgery[J].Dis Colon Rectum,2017,60(3):290-298.
[14]郑民华,马君俊.腹腔镜结直肠手术手术入路选择专家共识[J].中国实用外科杂志,2017,37(4):415-419.
[15]郑民华,马君俊.中国微创胃肠外科的创新与发展[J].中华消化外科杂志,2018,17(1):33-36.
[16]Feng B,Ling TL,Lu AG,et al.Completely medial versus hybrid medial approach for laparoscopic complete mesocolic excision in right hemicolon cancer[J].Surg Endosc,2014,28(2):477-483.
[17]叶凯,陈琦玮,许建华,等.腹腔镜右半结肠切除术血管解剖及处理[J].中华胃肠外科杂志,2017,20(8):953-954.
[18]Matsuda T,Iwasaki T,Sumi Y,et al.Laparoscopic complete mesocolic excision for right-sided colon cancer using a cranial approach:anatomical and embryological consideration[J].Int J Colorectal Dis,2017,32(1):139-141.
[19]Hunt SR.Right Colectomy:Straight Laparoscopic[M].New York:Springer;2015:53-60.
[2]汤思哲,王仆,田斐,等.有限中间入路腹腔镜右半结肠癌根治术的临床疗效[J].中华消化外科杂志,2019,18(1):91-95.
[3]Hohenberger W,Weber K,Matzel K,et al.Standardized surgery for colonic cancer:complete mesocolic excision and central ligationtechnical notes and outcome[J].Colorectal Dis,2009,11(4):354-364.
[4]West NP,Hohenberger W,Weber K,et al.Complete mesocolic excision with central vascular ligation produces an oncologically superior specimen compared with standard surgery for carcinoma of the colon[J].J Clin Oncol,2010,28(2):272-278.
[5]中华医学会外科学分会腹腔镜与内镜外科学组,中华医学会外科学分会结直肠外科学组,中国医师协会外科医师分会结直肠外科医师委员会,等.腹腔镜结直肠癌根治术操作指南(2018版)[J].中华消化外科杂志,2018,17(9):877-885.
[6]Clinical Outcomes of Surgical Therapy Study Group.A comparison of laparoscopically assisted and open colectomy for colon cancer[J].NEngl J Med,2004,350(20):2050-2059.
[7]Colon Cancer Laparoscopic or Open Resection Study Group,Buunen M,Veldkamp R,et al.Survival after laparoscopic surgery versus open surgery for colon cancer:long-term outcome of a randomised clinical trial[J].Lancet Oncol,2009,10(1):44-52.
[8]Jayne DG,Thorpe HC,Copeland J,et al.Five-year follow-up of the Medical Research Council CLASICC trial of laparoscopically assisted versus open surgery for colorectal cancer[J].Br J Surg,2010,97(11):1638-1645.
[9]Kaye T,West N,Jayne D,et al.CT assessment of right colonic arterial anatomy pre and post cancer resection-a potential marker for quality and extent of surgery[J]?Acta Radiologica,2016,57(4):394-400.
[10]Negoi I,Beuran M,Hostiuc S,et al.Surgical anatomy of the superior mesenteric vessels related to colon and pancreatic surgery:A systematic review and meta-analysis[J].Scientific Reports,2018,8(1):4184.
[11]Stefura T,Kacprzyk A,Dro?J,et al.The venous trunk of henle(gastrocolic trunk):A systematic review and meta-analysis of its prevalence,dimensions,and tributary variations[J].Clin Anat,2018,31(8):1109-1121.
[12]Ogino T,Takemasa I,Horitsugi G,et al.Preoperative evaluation of venous anatomy in laparoscopic complete mesocolic excision for right colon cancer[J].Ann Surg Oncol,2014,21(3):429-435.
[13]Kuzu MA,Ismail E,Celik S,et al.Variations in the vascular anatomy of the right colon and implications for right-sided colon surgery[J].Dis Colon Rectum,2017,60(3):290-298.
[14]郑民华,马君俊.腹腔镜结直肠手术手术入路选择专家共识[J].中国实用外科杂志,2017,37(4):415-419.
[15]郑民华,马君俊.中国微创胃肠外科的创新与发展[J].中华消化外科杂志,2018,17(1):33-36.
[16]Feng B,Ling TL,Lu AG,et al.Completely medial versus hybrid medial approach for laparoscopic complete mesocolic excision in right hemicolon cancer[J].Surg Endosc,2014,28(2):477-483.
[17]叶凯,陈琦玮,许建华,等.腹腔镜右半结肠切除术血管解剖及处理[J].中华胃肠外科杂志,2017,20(8):953-954.
[18]Matsuda T,Iwasaki T,Sumi Y,et al.Laparoscopic complete mesocolic excision for right-sided colon cancer using a cranial approach:anatomical and embryological consideration[J].Int J Colorectal Dis,2017,32(1):139-141.
[19]Hunt SR.Right Colectomy:Straight Laparoscopic[M].New York:Springer;2015:53-60.