腹腔镜下右半结肠癌根治术不同手术入路的疗效比较

Comparison of clinical outcomes of different operation approach in laparoscopic right hemicolectomy for right half colon cancer

目的比较不同手术入路进行腹腔镜下右半结肠癌根治术的疗效。方法将2008年12月至2013年12月在广州市第十二人民医院行腹腔镜下右半结肠癌根治术的216例患者分为两组,A组(90例)采用中间入路,B组(126例)采用侧方入路,比较两组手术时间、术中出血量、中转开腹率、淋巴结清扫数、并发症、术后镇痛时间、术后排气时间、住院时间,手术前后的肿瘤特异性生长因子(TSGF)和癌胚抗原(CEA)等情况。结果 A组手术时间(142.8±18.6)min、术中出血量(56.8±13.2)ml、术后排气时间(4.2±1.0)d,B组手术时间(121.4±14.2)min、术中出血量(41.6±8.6)ml、术后排气时间(2.8±0.8)d,两组比较差异有统计学意义(P<0.05);在中转开腹率、淋巴结清扫数、并发症、术后镇痛时间、住院时间、术后TSGF和CEA含量上,两组比较差异无统计学意义(P>0.05)。结论腹腔镜下行右半结肠癌根治术疗效明显,侧方入路操作安全、手术时间短、术中出血少、术后恢复快,值得在临床上进一步推广应用。

Objective To explore and compare the clinical outcomes of intermediate approach and lateral approach in laparoscopic right hemicolectomy for fight half colon cancer. Methods 216 patients with fight half colon cancer in our hospital from December 2008 to December 2013 were divided into two groups. Group A （n=90） was performed operation by intermediate approach while Group B （n =126） was performed operation by lateral approach. The clinical outcomes of two groups were observed and analyzed. Results Operation time, operative blood loss and postoperative exhaust time of Group B were significantly better than those of Group A （P〈0.05）. No significant differences in the rate of conversion to laparotomy, the number of lymph node cleaning, complications, postoperative analgesia time, hospitalization time, TSGF and CEA levels were showed（P〉0.0fi）. Conclusion The laparoscopic right hemicolcctomy with the lateral approach for the right colon cancer can effectively shorten the operation time, reduce the operation bleeding, and less time in recovery. It is worth popularizing in clinic.