腹腔镜右半结肠癌根治术优先处理Henle干的近期疗效分析

目的对比胃结肠静脉干（Henle干）的优先处理与传统处理在腹腔镜右半结肠癌根治术的近期疗效分析。 方法回顾性分析2018年6月至2019年6月期间同济大学附属上海东方医院胃肠外科80例行腹腔镜右半结肠癌根治术治疗结肠癌的临床资料,根据手术视频录像筛选,术中优先处理Henle干38例（优先组）,同期未优先处理Henle干（传统组）42例,比较两组的手术安全性及其近期疗效。 结果两组患者年龄、性别、体质量指数、肿瘤部位、肿瘤直径、肿瘤分期经比较,差异均无统计学意义（P>0.05）。与传统组相比,优先组术中出血量减少[（62.89±29.31）mL vs.（86.90±33.89）mL,t=3.372;P=0.001],手术时间缩短[（146.61±10.40）min vs.（159.21±21.60）min,t=3.270;P=0.002],术中血管损伤率降低[5.3%（2/38）vs. 21.4%（9/42）,χ²=4.396;P=0.036];两组术后并发症发生率、术后首次排气时间、术后首次排便时间、术后引流时间、术后住院时间、手术标本质量评价及病理学检查结果经比较,差异均无统计学意义（P>0.05）。 结论两组手术方式均为符合肿瘤根治性原则的有效手术,手术效果相当。在腹腔镜右半结肠癌根治术中优先处理Henle干在减少术中出血量,缩短手术时间,减少术中血管损伤方面具有优势,是安全可行的手术方式。

Analysis of the short-term clinical efficacy of the prior approach of Henle trunk in laparoscopic right hemi-colectomy for right colon cancer

ObjectiveTo compare the short-term clinical efficacy between prior and traditional approach of Henle trunk in laparoscopic right hemi-colectomy for right colon cancer. MethodsBetween June 2018 and June 2019, eighty cases who underwent laparoscopic right hemi-colectomy for right colon cancer in Gastrointestinal Surgery Department of Shanghai East Hospital Affiliated to Tongji University. According to the screening of operation videos, thirty-eight cases were given prior approach of Henle trunk (priority group) during the operation, while 42 cases (traditional group) were not given priority at the same time. A comparative, retrospective analysis was performed between the two groups in operative safety index and efficacy. ResultsAge, gender, body mass index, tumor location, diameter of tumor, tumor stage were not significantly different between the two groups (P>0.05). As compared to the traditional group, priority group was associated with significantly less estimated mean blood loss [(62.89±29.31) mL vs. (86.90±33.89)mL, t=3.372; P=0.001], shorter operative time [(146.61±10.40) min vs. (159.21±21.60) min, t=3.270; P=0.002], and lower intraoperative vascular damage rate [5.3% (2/38) vs. 21.4% (9/42), χ²=4.396; P=0.036]. There were no significantly differences between these two groups in terms of postoperative complications, first exhaust time, initial defecaton time, drainage time, postoperative hospitalization time, quality evaluation of surgical specimens and results of pathological examination. ConclusionBy using both two surgical approaches, radical resection of tumors could be achieved effectively in accordance with the principles of CME, and the operative effect was comparable. The prior process of Henle trunk in laparoscopic right hemi-colectomy for right colon cancer has advantages in less estimated blood loss, shorter operative time and lower intraoperative vascular damage rate. It is a safe and reliable treatment.