腹腔镜右半结肠切除中间入路与侧方入路的前瞻性随机对照研究

A prospective randomized control trial of the approach for laparoscopic right hemi-colectomy：medial-to-lateral versus lateral-to-medial

目的 对比中间入路法与传统侧方入路法在右半结肠癌行腹腔镜右半结肠切除术中的效果.方法 于2007年1月至2009年7月,将入院拟行手术治疗的48例右半结肠癌患者按随机数字表法前瞻性随机分为两组（各24例）,分别行中间入路和侧方入路腹腔镜右半结肠切除术,对比两组手术时间、术中出血量、淋巴结清扫情况、术中及术后并发症及术后住院时间.结果中间入路法与侧方入路法两组患者手术时间分别为（122.5±25.8）min及（162.9±30.9）min（P=0.01）;术中出血量分别为（55.8±36.2）ml及（104.6±58.2）ml（P=0.01）;差异均有统计学意义.两组术中并发症分别为4.2%和8.3%,术后并发症分别为8.3%和16.7%,淋巴结清扫数分别为（17.4±3.2）枚和（17.8±3.4）枚,术后住院时间分别为（7.8±2.2）d和（8.0±3.6）d,差异均无统计学意义（P＞0.05）.结论 中间入路法较传统的侧方入路法在腹腔镜右半结肠切除术中可明显缩短手术时间,减少术中出血量.

Objective To compare the medial-to-lateral approach with the lateral-to-medial approach in laparoscopic right hemi-colectomy for right colon cancer. Methods A prospective randomized controlled trial was performed in the Fujian provincial tumor hospital between January 2007 and July 2009. Forty-eight cases with right eolon cancer were randomly divided into two groups：medial-to- lateral laparoscopic right hemi-colectomy group（group M） and lateral-to-medial laparoscopic right hemicolectomy group（group L）. Primary outcome（operative time） and secondary outcomes （estimated blood loss, intra-operative complication, post-operative complication, number of lymph node retrieval, hospital stay） were compared between two groups. Results Operative time was （122.5±25.8） min in group M and （162.9±30.9） min in Group L （P=0.01）. Estimated blood loss was（55.8±36.2） ml in group M and （104.6±58.2） ml in group L （P=0.01）. There were no significant differences between the two groups in intra-operative complications（4.2% vs 8.3%, P=1.00）, post-operative complications （8.3% vs 16.7%,P=0.66）, number of lymph node retrieval （17.4±3.2 vs 17.8±3.4, P=0.67）, and hospital stay [（7.8± 2.2） d vs （8.0±3.6）d, P=0.81]. Conclusion The medial-to-lateral approach reduces operative time and blood loss in laparoscopic right hemi-colectomy as compared with the lateral-to-medial approach.