左手控制左半结肠切除术疗效分析

目的评价左手控制技术在左半结肠切除术中的应用要点及术后效果。方法对2000年3月至2009年3月36例采用左手控制技术左半结肠切除术患者的临床病理资料进行回顾性分析,并与和同期24例常规手术组患者相比较。结果观察组平均手术时间(46.3±15)min,对照组平均手术时间(65.9±24)min(P=0.035)。平均出血量观察组为(180±45)mL,对照组为(191±41)mL(P=0.035)。清扫淋巴结数观察组结肠旁、血管中间、血管根部分别是(5.9±3.8)、(2.7±3.2)、(1.8±2.1),总数为(10.4±7.6);对照组分别是(6.3±2.1)、(2.9±2.5)、(1.7±1.6),总数为(10.7±4.6)(P=0.05)。观察组无脾脏损伤病例,对照组2例患者出现脾脏损伤。观察组5年生存率为75.8%,对照组为64.3%(P=0.043)。观察组Ⅰ、Ⅱ、Ⅲ期分别是90.6%、79.3%、55.2%。对照组Ⅰ、Ⅱ、Ⅲ期分别是91.8%、73.7%、44.5%。结论左手控制左半结肠切除术更符合肿瘤手术原则,能降低手术操作难度,减少术后复发转移,增加生存率。

The Surgical Skill of Left Hand Contral Technique Utilized in Left Hemicolectomy

Objective To investigate the surgical skill of left hand contral technique in left hemicolectomy.Methods From Mar 2000 to Mar 2009 60 cases of colon cancer patients received lefthemicolectomy,among them 36 cases received operation with left hand contral technique,the clinical and pathological data were retrospectively analyzed and compared with 24 cases with routine way.Results The mean operative time of observed group was 46.3 ± 15min,the contrast group was（65.9 ± 24）min（P= 0.035）.The average amount of bleeding of observed group was（180 ± 45） mL,the contrast group was（191 ± 41） mL（P= 0.035）.The lymph nodes of paracolon,middle and radicle group of observed group was（5.9 ± 3.8）,（2.7 ± 3.2）,（1.8 ± 2.1）,the total number was（10.4 ± 7.6）;While in contrast groups was（6.3 ± 2.1）,（2.9 ± 2.5）,（1.7 ± 1.6）,the total total number was（10.7 ± 4.6）（P= 0.05）.No case complicatee with splenic injury in antegrade group,while 2 cases in the retrograde group.The 5-year survival rate of observed group was 75.8%,while 64.3% in contrast group（P= 0.043）.The 5-year survival rate of stageⅠ,Ⅱ,Ⅲ was 90.6%,79.3%,55.2% in observed group,the contrast group was 91.8%,73.7%,44.5%.Conclusion The excision of left hemicolectomy with eft hand contral technique was supreior to retrograde group.