手辅式腹腔镜右半结肠癌根治术在老年肥胖患者中的应用及评价

目的评价手辅式腹腔镜右半结肠癌根治术在老年肥胖患者中的疗效及应用价值。方法回顾性分析行手辅式腹腔镜右半结肠癌根治术的老年肥胖患者20例,并与同期行开腹右半结肠癌根治术的老年肥胖患者25例进行对照,对比两组的手术安全性、术后恢复、肿瘤根治性以及应激反应的指标。结果两组均无手术死亡病例,均行一期吻合,手辅式腹腔镜组（A组）无一例中转开腹;A组手术时间与开腹手术组（B组）差异无显著性（P〉0.05）;A组术中出血量少、术后体温恢复快、排气快、下床活动早,术后住院时间短,与开腹组相比较,差异具有显著性（P〈0.01）;A组手术切除标本长度、清扫淋巴结总数及术后并发症分别与B组相比较,差异无显著性（P〉0.05）;C反应蛋白、白介素6、促肾上腺皮质激素及皮质醇浓度两组手术后均明显升高,但B组升高比A组明显（P〈0.05）。结论运用手辅式腹腔镜技术能集中开放和腹腔镜手术的优势完成复杂的手术,手辅式腹腔镜右半结肠癌根治术对肥胖患者是一种安全、有效的手术方式,对术后恢复和机体应激反应有明显的改善,能体现出微创的优势,有较高的临床应用价值。

Clinical application and evaluation on hand-assisted laparoscopic right hemicolectomy for right colon carcinoma in elderly obese patients

Objective To evaluate the clinical application of hand-assisted laparoscopic right hemicolectomy for right colon carcinoma in elderly obese patients.Methods Twenty obese patients underwent hand-assisted laparoscopic right hemicolectomy were retrospectively reviewed,and compared with 25 obese patients with transabdominal right hemicolectomy in the same period.Results In hand-assisted laparoscopic group,there were less bleeding loss,rapidly recovery to normal temperature and gastrointestinal function,out of bed activity and eating,shortened hospitalization compared with transabdominal group（P〈0.01）.There were no significant differences in operative time,numbers of lymph nodes removed,postoperative complications and length of specimen（P〉0.05）between two groups.Concentrations of CRP,IL-6,ACTH and cortisol were significantly increased in two groups after operation than before operation（P〈0.05）,and this increase was more prominent in transabdominal group than in hand-assisted laparoscopic group（P〈0.05）.Conclusion Hand-assisted laparoscopic approach with HandPort system make the best use of the advantages of both open and laparoscopic surgery and bypass their weakness.Hand-assisted laparoscopic right hemicolectomy for right colon carcinoma is a safe and minimally invasive surgery for elderly obese patients.