腹腔镜内侧入路右半结肠癌根治术临床观察

Effect of laparoscopic right hemicolectomy through medial approach on colon cancer

目的探讨腹腔镜辅助内侧入路右半结肠癌根治术的方法和疗效。方法回顾性分析2008年5月-2010年6月解放军总医院普通外科行右半结肠癌根治术患者112例临床资料,腹腔镜组(LAP)52例,开腹手术组(OS)60例。结果两组性别构成及年龄无统计学差异(P=0.547,P=0.788);腹腔镜组与开腹组在术中出血量[(100±70)ml vs(210±85)ml,P=0.037]、术后镇痛时间[(19.2±8.5)h vs(58.3±12.2)h,P=0.033]、术后排气时间[(3.3±1.1)d vs(5.5±1.6)d,P=0.045]及总住院天数[(11.9±5.8)d vs(17.5±10.2)d,P=0.012]差异显著;在手术时间、切除标本长度、淋巴结清扫数目、术后发生吻合口瘘和肠梗阻,以及1年内局部复发率和肝转移率方面无统计学差异;腹腔镜组1例因肿瘤侵及十二指肠行中转开腹。结论腹腔镜辅助右半结肠癌根治术符合肿瘤根治原则,术后患者恢复较快,近期疗效较好,值得推广。

Objective To study the therapeutic effect of laparoscopic right hemicolectomy through medial approach on colon cancer.Methods Clinical data about 112 patients with right colon cancer admitted to Department of General Surgery,Chinese PLA General Hospital,from May 2008 to June 2010,were retrospectively analyzed.The patients were divided into laparoscopic（LAP） group（n=52） and open surgery（0S） group（n=60）.Results No significant difference was found in gender and age between the two groups（P〉0.05）.The intraoperative blood loss,postoperative analgesia time,postoperative flatus passage time,and total hospital stay time were significantly lower in LAP group than in OS group（（100±70）ml vs（210±85）ml,（19.2±8.5）h vs（58.3±12.2）h,（3.3±1.1）d vs（5.5±1.6）d,and（11.9±5.8）d vs（17.5±10.2）d,P〈0.05）.However,no significant difference was observed in operation time,sample length,removed lymph nodes,anastomotic leakage,postoperative ileus,one year local recurrence and liver metastasis rate between the two groups.One patient in LAP group was converted to laparotomy due to tumor invasion of duodenum.Conclusion Laparoscopic right hemicolectomy through medial approach is a technically safe procedure for colon cancer with a rather good short-term therapeutic effect and a rapid recovery time of patients,thus worthy to be popularized