手辅式腹腔镜右半结肠癌根治术在不同体重人群中的疗效评价

目的评价手辅式腹腔镜右半结肠癌根治术在不同体重人群中的近期临床治疗效果是否优于传统的开腹右半结肠癌根治术。方法选取2002年1月至2006年12月行手辅式腹腔镜右半结肠癌根治术的48例患者为病例组（A组）,配对选取开腹右半结肠癌根治术的48例患者为对照组（B组）,考虑体重因素对手术疗效的影响,对病例组和对照组按成人体重分级标准分成正常组（1组）和肥胖组（2组）,交叉组成4组,分别为正常体重病例组（A1组）、肥胖病例组（A2组）、正常体重对照组（B1组）和肥胖对照组（B2组）,各为24例;观察指标包括手术时间及术中出血量、体温恢复时间、进食时间、肛门排气时间、下床活动时间、切除标本长度、清扫淋巴结数目、术后住院时间、术后近期恢复情况、术后并发症发生率、住院费用和手术相关费用。结果A1组比B1组手术时间长（P〈0.05）,但术中出血量、手术切除标本长度、清扫淋巴结总数及手术并发症差异无统计学意义（P〉0.05）;A2组与B2组手术时间、手术切除标本长度、清扫淋巴结总数及手术并发症差异无统计学意义（P〉0.05）,但A2组出血量较B2组少（P〈0.05）。A1组与B1组体温恢复时间、下床活动时间、术后住院时间、并发症发生率差异均无统计学意义（P〉0.05）,A1组进食时间、肛门排气时间较B1组缩短（P〈0.05）;A2组体温恢复时间、进食时间、肛门排气时间、下床活动时间、术后住院时间均比B2组缩短（P〈0.05）。A1组手术相关费用和住院总费用均比B1组高（P〈0.05）,A2组手术相关费用比B2组高（P〈0.05）,但住院总费用两者相比差异无统计学意义（P〉0.05）。结论手辅式腹腔镜右半结肠癌根治术在正常体重人群的应用没有体现出优势,但在肥胖人群中有显著的优势,手辅式腹腔镜右半结肠癌根治术对肥胖患者是一种安全、有

Clinical evaluation of hand-assisted laparoscopic hemicolectomy for right colon carcinoma among people with different levels of body mass index

Objective To study the clinical effects of hand-assisted laparoscopic hemicolectomy among people with different levels of body mass index performed for right colon carcinoma compared to open surgery. Methods From January 2002 to December 2006, information was collected from theatre records. In additional to avoid the influence of body weight to evaluate therapy outcomes, patients were classified as normal weight and obesity according to adult body weight classification. Evaluation factors included：operative time,blood loss, length of specimen resection, clearance of lymph nodes, postoperative short-term recovery outcomes, incidences of postoperative complications and hospitalized costs. Results There were no significant differences in terms of median operative time,blood loss, length of specimen excision, clearance of lymph nodes, and incidence rates of complication in patients of normal weight between hand-assisted laparoscopic group and the open group. There were also no differences in obesity patients between both groups, except blood loss was less in laparoscopic group than in the open group. In patients of normal weight, differences in temperature recovery time, median days to motion out of bed, hospital days, were not significant between two groups. However,laparoscopic group was associated with shorter time to diet and to pass flatus than open group. In obesity patients, laparoscopic group was associated with earlier recovery to normal temperature, earlier return to out of activity, and shorter hospital Stay compared to open group. In patients of normal weight,laparoscopic group required more operation costs and hospitalized costs than open group. In obesity patients,laparoscopic group needed more operation costs than the open group, however, hospitalized costs of both groups are comparable. Conclusions In conclusion, this study has shown no evidence of any alteration in the pattern of short-term outcomes after hand-assisted laparoscopic and conventional surgery for right colonic carcinoma in patients of