目的 探讨小儿结肠系膜淋巴管瘤的诊断与治疗方法。方法 回顾性分析我院2006年1月至2011年12月期间手术治疗的5例小儿结肠系膜淋巴管瘤的临床资料。结果 3例诊断为腹腔包块性质待查的患儿，术中发现腹腔肿块来源于乙状结肠系膜，其中1例肿块侵犯到降结肠系膜达结肠脾曲而行左半结肠切除＋肠吻合术，另外2例行乙状结肠系膜淋巴管瘤切除＋部分乙状结肠切除＋肠吻合术；1例患儿诊断为急性化脓性阑尾炎合并乙状结肠系膜淋巴管瘤，行阑尾切除＋乙状结肠系膜淋巴管瘤切除＋肠吻合术，1例患儿诊断为乙状结肠系膜淋巴管瘤破裂并弥漫性腹膜炎，行乙状结肠系膜淋巴管瘤切除＋乙状结肠造瘘术，术后6个月后再行二期手术。5例患儿手术后恢复良好，未发生吻合口漏等并发症。术后随访5个月～5年， （2.3±1.1）年，1例失访，余均存活，仍在随访中，所有病例均未复发。结论 日常行阑尾手术中，应常规探查小肠、结肠；未进行肠道准备的结肠一期吻合手术中结肠灌洗可减少吻合口漏等并发症的发生率；腹腔感染严重的患儿结肠一期吻合不可取，结肠造瘘安全；小儿结肠系膜淋巴管瘤术前确诊困难，反复出现腹痛、腹部包块的患儿应想到结肠系膜淋巴管瘤的可能性，行充分的肠道准备后择期手术，手术是肠系膜淋巴管瘤唯一的治疗方法。
ObjectiveTo summarize the progress of surgical treatment of colorectal cancer in recent years from the anatomical features of the mesorectum, aiming to provide a new basis for surgical treatment of colorectal cancer. MethodThe relevant literatures about total mesorectal excision and complete mesocolic excision in colorectal cancer surgery in recent years were reviewed. ResultsTotal mesorectal excision and complete mesocolic excision significantly reduced the local recurrence rate of patients with colorectal cancer, improved the tumor-free survival rate and overall survival rate, and significantly improved the prognosis of patients, which may benefited from the surgeon’s detailed anatomy of mesenteric plane. In addition, based on current evidence, total mesorectal excision for colorectal cancer was safe and had fewer postoperative complications, which helped to promote the standardization of surgical treatment of colorectal cancer. ConclusionsTotal mesorectal excision and complete mesocolic excision can significantly improve histopathological prognosis compared with conventional surgery, but the advantages of long-term oncological prognosis need further study. In recent years, the combination of new techniques such as laparoscopy, robotic surgery and natural lumens, and mesenteric resection has provided new directions and new ways for surgical treatment of colorectal cancer.
ObjectiveTo investigate the clinical effect and prognosis of laparoscopic complete mesocolic resection (CME) in the treatment of elderly patients with stage Ⅲ right colon cancer.MethodsClinical data of 280 elderly patients (aged 60 years or older) who underwent stage Ⅲ right hemicolectomy in the First Hospital of Lanzhou University from 2010 to 2015 were collected. Among them, 160 patients underwent laparoscopic CME treatment were set as the observation group, and 120 patients underwent conventional laparotomy were set as the control group. The mean operative time, intraoperative blood loss, postoperative first anal exhaust time, number of lymph nodes dissection, number of positive lymph nodes, length of hospital stay and postoperative complications were compared between the two groups. The postoperative local recurrence rate, distant metastasis rate, 3-year cumulative survival rate and postoperative recurrence risk factors were analyzed.ResultsThere were no statistically significant differences between the observation group and the control group in operative time, number of lymph node dissection, number of positive lymph nodes and postoperative distant metastasis rate (P>0.05). The amount of intraoperative blood loss, postoperative anal first exhaust time, days of hospitalization, and postoperative recurrence rate in the observation group were less or shorter or lower than those in the control group, with statistically significant differences (P<0.05). The 3-year survival rate in the observation group was higher than that in the control group (log-rank χ2 =11.865, P=0.001), and the disease free survival in the observation group was also higher than that in the control group (log-rank χ2=7.567, P=0.006). Logistic regression was used to analyze the cases of postoperative recurrence in the two groups, and it was found that the degree of tumor differentiation, vascular invasion and lymph node metastasis were independent risk factors for postoperative tumor recurrence.ConclusionLaparoscopic CME in the treatment of elderly patients with stage Ⅲ right colon cancer is effective, it is safe and feasible, which can effectively prolong the survival time of patients.
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 an 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.
ObjectiveLymph node metastasis status directly influences surgical strategies for right-sided colon cancer. This real-world study aimed to clarify the patterns of regional and extra-regional lymph node metastasis to provide evidence for clinical decision-making and future research. MethodsA total of 123 patients who underwent laparoscopic right hemicolectomy with complete mesocolic excision (CME) at the Department of Gastrointestinal Surgery, Deyang People’s Hospital from September 2022 to May 2024 were included. Lymph nodes were dissected, classified, and analyzed according to the Japanese Society for Cancer of the Colon and Rectum Guidelines for Colorectal Cancer Treatment (7th edition). Clinicopathological data were analyzed. ResultsOverall lymph node metastasis rate:42.3% (52/123). The metastasis rate of para-intestinal lymph nodes (N1) was 33.3%(41/123), intermediate lymph node(N2) 10.6%(13/123), and central lymph node (N3) 13.8% (16/123). Cecal cancer: Ileocolic artery lymph node metastasis rate: 40.0% (10/25), right colic artery: 0% (0/6) and middle colic artery: 4.0% (1/25). Transverse colon cancer: Ileocolic artery lymph node metastasis rate: 0%(0/18) and middle colic artery: 33.3% (6/18). Of 45 patients with infrapyloric lymph node dissection, only 1 (2.2%) with hepatic flexure cancer showed metastasis. No ileal lymph node metastasis was observed. N3 metastasis rates: 9.3% (8/86) in well/moderately differentiated tumors vs. 21.6% (8/37) in poorly differentiated tumors. No N3 lymph node metastasis occurred in T1～2 tumors. T3 and T4 tumors exhibited N3 metastasis rates of 13.3% (13/98) and 21.4% (3/14), respectively. ConclusionsFor cancer of the ileocecal region, lymph node metastasis beside the colic middle artery almost never occurs. And for transverse colon cancer, no lymph node metastasis beside the ileocolic artery has been found. suggesting that when the tumor is located in these areas, excessive resection of the intestine is not necessary, and a right hemicolectomy with ileocecal preservation can be performed to better preserve organ function. For poorly differentiated cancers and right-sided colon cancers on T3 and T4 stages, the N3 lymph node metastasis rates are very high, respectively, and D3 lymph node dissection is still recommended. The rate of extra-regional lymph node metastasis is extremely low, and routine dissection is not recommended.