腹腔镜技术较开腹术治疗右半结肠癌的疗效比较及入路探讨

目的比较腹腔镜技术较开腹术治疗右半结肠癌的疗效及入路选择探讨。 方法回顾性分析2015年6月至2017年4月接受手术治疗的97例右半结肠癌患者资料，根据术式不同分为开腹组(32例，开腹手术)、传统组(35例，侧方入路的腹腔镜根治术)和SMA组(30例，动脉优先入路的腹腔镜根治术)。采用SPSS 23.0统计分析软件，围术期相关指标等计量资料以( ±s)表示，多组间比较采用单因素方差分析；并发症总发生率比较采用χ²检验；累积生存率比较应用Log-Rank检验，均采用双侧检验。P<0.05为差异有统计学意义。 结果与传统组和SMA组相比，开腹组手术时间较短，术后排气时间、住院时间较长，术中出血量较多，差异均有统计学意义(P<0.05)。传统组手术时间、术后排气时间、住院时间与SMA组比较，差异均不明显(P>0.05)；SMA组淋巴结清扫数量、阳性淋巴结清扫数量比开腹组、传统组多，术中出血量比开腹组、传统组少(P<0.05)。术后并发症总发生率开腹组为28.1%，传统组为8.6%，SMA组为6.7%，三组比较开腹组>传统组>SMA组(P<0.05)。术后3年生存率开腹组为65.6%，传统组为65.7%，SMA组为70.0%，三组差异无统计学意义(P>0.05)。 结论腹腔镜技术应用于治疗右半结肠癌可减少对机体的创伤，有利于术后恢复，同时以动脉优先入路可增加淋巴结清扫范围。

Comparison of the curative effect and approach of laparoscopic surgery and laparotomy in the treatment of right colon cancer

ObjectiveTo compare the efficacy of laparoscopic surgery with laparotomy in the treatment of right colon cancer and to explore the approach choices. MethodsThe clinical data of 97 patients with right colon cancer who underwent surgery in our hospital from June 2015 to April 2017 were analyzed retrospectively. According to the different surgical methods, they were divided into open group (32 cases, laparotomy), traditional group (35 cases, laparoscopic radical operation with lateral approach) and SMA group (30 cases, laparoscopic radical operation with arterial preference approach). Statistical analysis were performed by using SPSS 23.0 software. Measurement data such as perioperative related indicators that conformed to normal distribution were expressed as ( ±s), and one-way analysis of variance was used for comparison between multiple groups Total incidence of complications and were expressed as rates, χ² test was used for comparison among multiple groups. Log-Rank test was used to compare cumulative survival rates, and bilateral tests were used. A P value of <0.05 was considered as statistically significant difference. ResultsCompared with the traditional group and the SMA group, there were shorter operation time, longer postoperative exhaust time and hospital stay, and more intraoperative blood loss in the laparotomy group (P<0.05). There were not significantly difference between the SMA group and the traditional group in terms of the operation time, postoperative exhaust time, and hospitalization time (P>0.05). There more harvested lymph nodes and more positive lymph nodes in the SMA group than those in the laparotomy group and the traditional group respectively, while intraoperative bleeding was less than that in the laparotomy group and the traditional group (P<0.05). The total incidence of complications was 28.1% in the open group, 8.6% in the traditional group and 6.7% in the SMA group. In terms of total incidence of postoperative complications among the three groups, the laparotomy group > traditional group > SMA group (P<0.05). However, compared with the SMA group, the total incidence of complications in the traditional group was not significantly different (P>0.05). The 3-year survival rate in the laparotomy group was 65.6%, while 65.7% in the traditional group and 70.0% in the SMA group, with no statistically significant difference (P> 0.05). ConclusionThe application of laparoscopic technology in the treatment of right colon cancer could reduce the trauma to the body and facilitate postoperative recovery. At the same time, the priority of arterial approach could increase the range of lymph node dissection, however without obvious advantage in improving the prognosis.