单孔加一腹腔镜技术在根治性右半结肠癌手术中的应用

目的比较"单孔加一"与常规5孔法完全腹腔镜技术在右半结肠癌手术中的近期疗效、术后肠道功能恢复及机体应激及炎性反应状态,以探讨"单孔加一"腹腔镜技术在根治性右半结肠癌手术中的可行性和优势。方法采用回顾性队列研究方法,收集2018年1月至2020年9月期间,在福建省肿瘤医院胃肠外科接受单孔加一孔腹腔镜右半结肠手术的35例患者(SILS+1组)的临床资料,并将同期采用常规5孔法行完全腹腔镜右半结肠手术的44例患者作为传统组(CLS组)。比较两组术中观察指标(手术时间、术中出血量、切口长度)及术后观察指标(术后首次下地时间、首次排气时间、术后前3 d疼痛评分、住院天数、淋巴结清扫个数、疼痛评分、术后并发症发生率、术后总蛋白、白蛋白及C-反应蛋白指标)。结果两组均无中转开腹或腹腔镜辅助手术,均成功完成全腔镜下根治性右半结肠癌切除术。两组性别、年龄、体质指数、肿瘤分期方面差异均无统计学意义(均P>0.05),具有可比性。与CLS组相比,SILS+1组总切口长度更短(5.1±0.6)cm比(8.5±4.1)cm,t=4.124,P=0.012],首次下地中位时间(中位数:27.6 h比49.3 h,Z=4.386,P=0.026)及首次排气中位时间(42.8 h比63.2 h,Z=13.086,P=0.012)更早,术后疼痛更轻术后1d:(2.0±1.1)分比(3.6±0.9)分;术后2 d:(1.4±0.2)分比(2.9±1.4)分,术后3 d:(1.1±0.1)分比(2.3±0.3)分,F=49.128,P=0.003],术后住院时间(9.1±2.7)d比(11.2±2.2)d,t=3.267,P=0.001]更短,差异均具有统计学意义(均P<0.05)。术后第2天复查,发现SILS+1组的总蛋白水平高于CLS组(59.7±18.2)g/L比(43.0±12.3)g/L,t=2.214,P=0.003]、白蛋白水平高于CLS组(33.6±7.3)g/L比(23.7±5.4)g/L,t=5.845,P<0.001],C-反应蛋白水平低于CLS组(16.3±3.1)g/L比(63.3±4.5)g/L,t=4.961,P<0.001],差异均具有统计学意义。两组患者的手术时间、术中出血量、淋巴结清扫数、淋巴结转移数及术后并发症发生率比较,差异均无统计学意义(均P>0.05)。结论"单孔加一"技术具有良好的可操作性及潜在推广价值,在具有与传统腹腔镜同等根治度的前提下,该技术可减少手术切口数目,减轻术后疼痛,加快术后恢复,缩短住院时间。

Application of single incision plus one port laparoscopic surgery in radical right hemicolon cancer surgery

Objective To investigate the feasibility and advantages of the SILS+1 technique in the radical right hemicolectomy,by comparing the short-term efficacy,postoperative recovery of intestinal function,and stress and inflammatory response of patients with right-sided colon cancer undergoing the conventional 5-hole laparoscopic technique or the single incision plus one port laparoscopic surgery(SILS+1).Methods A retrospective cohort study was performed.Thirty-five patients with right-sided colon cancer undergoing SILS+1 surgery at Department of Gastrointestinal Surgery of Fujian Cancer Hospital from January 2018 to September 2020 were enrolled in the SILS+1 group.Then a total of 44 patients who underwent completely 5-hole laparoscopic right hemicolectomy at the same time were selected as the conventional laparoscopic surgery(CLS)group.The intraoperative observation indexes(operative time,intraoperative blood loss,and incision length)and postoperative observation indexes(time to ambulation after surgery,time to flatus,pain score in the first 3 days after surgery,hospitalization days,number of lymph node dissections,postoperative complication morbidity,and postoperative total protein,albumin and C-reaction protein)were compared between the two groups.Results There was no conversion to laparotomy or laparoscopic-assisted surgery in both groups.All the patients successfully completed radical right hemicolectomy under total laparoscopy.There were no statistically significant differences in gender,age,body mass index or tumor stage between the two groups(all P>0.05).Compared with the CLS group,the SILS+1 group had shorter incision length(5.1±0.6)cm vs.(8.5±4.1)cm,t=4.124,P=0.012],shorter time to the first ambulation(median:27.6 h vs.49.3 h,Z=4.386,P=0.026),and shorter time to the first flatus(median:42.8 h vs.63.2 h,Z=13.086,P=0.012),lower postoperative pain score postoperative 1-d:2.0±1.1 vs.3.6±0.9;postoperative 2-d:1.4±0.2 vs.2.9±1.4;(postoperative 3-d:1.1±0.1 vs.2.3±0.3,F=49.128,P=0.003),shorter postoperative hospital stay(9.1±2.7)d vs.(11.2±2.2)d,t=3.267,P=0.001],which were all statistically significant(all P<0.05).On the second day after surgery,as compared to CLS group,SILS+1 group had higher total protein level(59.7±18.2)g/L vs.(43.0±12.3)g/L,t=2.214,P=0.003],higher albumin level(33.6±7.3)g/L vs.(23.7±5.4)g/L,t=5.845,P<0.001],but lower C-reactive protein level(16.3±3.1)g/L vs.(63.3±4.5)g/L,t=4.961,P<0.001],which were all statistically significant.There were no significant differences in the operative time,intraoperative blood loss,number of harvested lymph node,number of metastatic lymph node,and postoperative complication morbidity(all P>0.05).Conclusions The SILS+1 technique has good operability and potential for popularization.Under the premise of radical resection,this technology not only reduces incision number and postoperative physical pain,but also speeds up postoperative recovery and shortens hospital stay.