目的 探讨腹腔镜全结肠切除术在家族性腺瘤性息肉病（FAP）中的应用价值。方法 回顾性分析我院2008年1月至2009年10月期间收治的行腹腔镜全结肠切除术的4例FAP患者的临床资料，对手术安全性和术后恢复情况进行分析。结果 4例患者均顺利行腹腔镜全结肠切除术，无中转开腹，无手术并发症及死亡。腹部切口长6.0 cm，手术时间300～380 min（平均330 min），术中出血量90～250 ml（平均160 ml）。术后2～3 d肛门开始排气，术后住院时间7～11 d（平均9 d）出院。出院后大便稀薄，8～12次/d，给予易蒙停治疗后缓解。随访2～22个月（平均14个月），无近期并发症发生。结论 腹腔镜全结肠切除术治疗FAP安全、有效，近期效果良好。
Objective To assess clinical outcomes of hand assisted laparoscopic right hemicolectomy (HALC) and standard laparoscopic right hemicolectomy (SLC). Methods The databases of Wanfang, CNKI, VIP, CBM, PubMed, Embase, and Cochrane Central Register of Controlled Trials were electronically searched. The relevant literatures were selected according to the inclusion and exclusion criteria. The Cochrane collaboration tool for assessing risk of bias was used to assess the quality of randomized controlled trials and the Newcastle-Ottawa Scale was used to assess non-randomized comparative studies. Meta-analysis was performed by using RevMan 5.3 software. Results A total of 9 studies were included and involved 976 patients (480 patients in the HALC group and 496 patients in the SLC group). The results of meta-analysis showed that the HALC group was favor of shorter operative time as compared with the SLC group (P<0.05), but the length of incision and hospital stay were longer in the HALC group (P<0.05). There were no statistically significant differences between these two groups regarding as the conversion rate, time to return of bowel function, feeding time, reoperative rate during hospitalization, postoperative complications rate, and harvested lymph node number (P>0.05). As for the follow-up results, the 3-year survival rate was about 90%, and 5-year survival rate was about 80%, and there were no statistical differences in terms of recurrence rate and mortality between the HALC group and the SLC group (P>0.05). Conclusions Both HALC and SLC could achieve satisfactory minimal invasive outcomes and oncologic radical effects, and HALC has an advantage of shorter operative time, yet length of incision and hospital stay are longer than SLC. Therefore, HALC could be considered as an alternative to minimal invasive right hemicolectomy.
ObjectiveTo explore the prevalence and adjacency of the tributaries of superior mesenteric vessel. MethodsThis study is a prospective study. The patients with right-sided colonic malignant tumor who underwent laparoscopic complete mesocolon excision at the Division of Colorectal Surgery of Peking Union Medical College Hospital from July 2016 to September 2022 were collected. The real-time observation and evaluation of vascular anatomy was performed by the operator and recorded by a resident. The continuous variables without a normal distribution were summarized as median (P25, P75). The categorical variables were presented as number (%). ResultsA total of 200 patients were enrolled, including 114 males and 86 females, with a median age of 63.5 (53.5, 72.0) years. The prevalence of ileocolic artery and vein was 98.0% (196/200) and 98.5% (197/200), respectively. There were 168 (86.2%) cases of the ileocolic vein accompanied the course of the ileocolic artery at the origin in 195 patients with simultaneous presence of ileocolic artery and vein. The right colic artery and vein was present in 39.5% (79/200) and 18.5% (37/200) patients, respectively. The prevalence of the middle colic artery and vein was 96.5% (193/200) and 90.5% (181/200), respectively. And the prevalence of the middle colic vein accompanied the path of the middle colic artery at the root was 67.8% (118/174) in the 174 patients with simultaneous presence of middle colic artery and vein. The trunk length of the middle colic artery was 2.2 (1.6, 3.2) cm. The Henle trunk was present in 185 (92.5%) cases, with a trunk length of 1.00 (0.50, 1.40) cm, and its lower edge was 2.80 (2.20, 3.30) cm from the junction of the pancreatic head and the horizontal part of the duodenum. ConclusionsThe results from the data analysis of this study suggest that the ileocolic artery and vein are present most constantly with a high incidence of the ileocolic vein accompanied the course of the ileocolic artery at the origin of superior mesenteric vessels. Therefore ileocolic artery and vein are expected to serve as an optimal anatomical landmarks for the caudal-to-cranial medial approach in laparoscopic complete mesocolon excision.