腹腔镜下右半结肠切除术尾侧联合中间入路与中间入路的疗效比较

目的探讨腹腔镜下右半结肠切除术尾侧联合中间入路与中间入路的疗效比较。 方法将2015年3月~2018年9月收治于长江大学附属第一医院拟行腹腔镜右半结肠癌根治切除的患者,按随机数字表随机分为两组,分别是尾侧联合中间入路组（观察组56例）和中间入路组（对照组53例）,比较两种不同入路的手术时间、术中出血量、淋巴结清扫数目、中转开腹情况及术后肛门排气时间、进食流质时间、术后住院时间、并发症情况。 结果尾侧联合中间入路组与中间入路组的手术时间分别为（123.5±23.2）min及（148.3±30.1）min,术中出血量分别为（32.5±23.2）mL及（61.3±27.8）mL,差异均有统计学意义（t=4.833,5.885;P<0.05）;淋巴结清扫个数分别（22.3±4.60）个及（23.1±4.52）个,差异无统计学意义（t=0.915,P>0.05）;两组中转开腹各1例,差异无统计学意义（χ²=0.000,0.000;P>0.05）;两组患者术后肛门排气时间分别为（3.59±0.66）d及（3.62±0.62）d,进食流质时间分别为（4.16±0.72）d及（4.22±0.65）d,术后住院时间分别（9.27±2.10）d及（9.73±2.40）d,差异均无统计学意义（t=1.016,0.875,0.425;P>0.05）;两组患者均无围手术期死亡病例;尾侧联合中间入路组腹腔感染1例,肠梗阻1例,中间入路组切口感染1例,吻合口漏1例,差异无统计学意义（χ²=0.000,P>0.05）。 结论在腹腔镜右半结肠癌根治手术中,采用尾侧联合中间入路较中间入路可明显缩短手术时间,减少术中出血量,且手术更容易操作、安全、易配合,值得临床积极应用。

Study of the curative effect of laparoscopic right hemicolectomy by caudal combined intermediate approach and intermediate approach

ObjectiveTo investigate the efficacy of of two kind of approaches: caudal approach and central approach in laparoscopic radical resection of right colon cancer. MethodsPatients who underwent laparoscopic radical resection of right colon cancer in the First affiliated Hospital of Yangtze University from March 2015 to September 2018 were randomly divided into two groups according to the random number table: the caudal approach group (56 patients in the observation group) compared with the intermediate approach group (53 patients in the control group). The operation time, intraoperative blood loss, number of lymph node dissection, and intraoperative and postoperative complications were compared between the two different approaches. ResultsThe operation time of the caudal approach group and the medial approach group were (123.5±23.2) min and (148.3±30.1) min, respectively. The intraoperative blood loss was (32.5±23.2) mL and (61.3±27.8) mL, respectively. There were statistical significance (t=4.833, 5.885; P<0.05). The number of lymph node dissection was (22.3±4.60) and (23.1±4.52), and it was not statistically significant in this index (t=0.915, P>0.05). There were one case with open surgery respectively in two groups. The difference was not statistically significant in above indexes (χ²=0.000, 0.000; P>0.05). The time of anal exhaust was (3.59±0.66) d and (3.62±0.62) d, the time of feeding fluid was (4.16±0.72) d and (4.22±0.65) d, the time of hospitalization was (9.27±2.10) d and (9.73±2.40) d, respectively. There was no significant difference (t=1.016, 0.875, 0.425; P>0.05); there was no perioperative death in the two groups; one case of abdominal infection and one case of intestinal obstruction in the caudal combined approach group; one case of incision infection and one case of anastomotic leakage in the middle approach group; the difference was not statistically significant (χ²=0.000, P>0.05). ConclusionThe laparoscopic radical operation of right colon cancer with the use of caudal approach can significantly shorten the operation time and reduce the amount of intraoperative blood loss. It is simpler, safer and easier to cooperate. It is worthy of clinical application.