内窥镜器械鞘改良腹腔镜手术在右半结肠癌治疗中的应用

Usage of endoscope sheath advanced laparoscopic versus open surgery in right-side colon cancer

目的探讨采用内窥镜器械鞘改良腹腔镜行右半结肠癌根治术的效果。方法行右半结肠癌根治术的右半结肠癌患者325例,随机分为改良组110例,行内窥镜器械鞘改良腹腔镜手术;传统组108例,行传统腹腔镜手术;开腹组107例,行开腹手术。比较三组手术时间、术中出血量、术后住院时间、术后排气时间、清扫淋巴结总数、住院期间并发症发生情况以及住院天数。对所有患者进行随访观察,比较三组3年累计生存率。结果改良组和传统组分别有1、3例中转开腹治疗。手术时间开腹组<改良组<传统组,术中出血量改良组和传统组少于开腹组(P均<0.05)。改良组淋巴结清扫个数多于传统组(P<0.05)。改良组与传统组患者术后排气时间、下床活动时间、进食时间及住院时间均较开腹组明显缩短(P均<0.05),且改良组患者术后下床时间和住院时间较传统组显著缩短(P均<0.05)。三组患者住院期间切口感染、肠瘘、肠粘连以及肺部感染的发生情况相近(P均>0.05)。改良组、传统组、开腹组3年累计生存率分别为72.48%、70.47%、67.56%(P均>0.05)。结论采用内窥镜器械鞘改良腹腔镜行下右半结肠根治术效果好,创伤小、应用安全,患者长期生存率与开腹手术相似。

Objective To compare the efficacy of endoscope sheath advanced laparoscopic versus open surgery in right-side colon cancer. Methods A total of 325 consecutive patients with right-side colon cancer were enrolled and divid- ed into advanced laparoscopic surgery group （n = 109 ）, traditional laparoscopic surgery group （n = 105 ） and open surgery group （ n = 111 ） randomly. The clinical data were collected and analyzed, including the operative time, blood loss, ex- haust time, complications, and duration of hospital stay. All patients were fallowed up to compare cumulative survival rates of three groups. Results The number of conversion to open surgery in advanced laparoscopie surgery group and traditional laparoscopic surgery group was 1 case and 3 cases, respectively. The operative time in open surgery group was shorter than the other two groups （ all P 〈 0.05 ）. The volumes of blood loss were smaller in both advanced and traditional groups （ all P 〈 0.05 ）. More lymphonodi was cleared in advanced group than that in traditional laparoscopic surgery group. There were significant improvements in exhaust time, incidences of operative complications, durations of hospital stay in laparoseopic surgery groups （ all P 〈 0.05 ）. After 3-year follow-up, there was no significant difference in cumulative survival rate among the three groups （ all P 〉 0.05 ）. Conclusion Endoscope sheath advanced laparoscopic colectomy is safe and effective in the treatment of right-side colon cancer.