手助腹腔镜与全腹腔镜在右半结肠癌根治术中应用的前瞻性病例对照研究

Prospective case control study on the hand-assistant laparoscopic and total laparoscopic radical right colectomy

目的探讨手助腹腔镜与全腹腔镜在右半结肠癌根治术中的应用价值,对比分析两种术式的优劣,为术式选择提供客观依据。方法 316例右半结肠癌患者分别采用手助腹腔镜右半结肠癌根治术(手助腹腔镜组,n=167)和全腹腔镜右半结肠癌根治术(全腹腔镜组,n=149)行右半结肠癌根治术。分析指标包括手术时长、术中出血量、术后疼痛级别、术后引流量、切口美容评分、住院时间、住院费用及并发症比率等。结果手术时长、术中出血量及术后引流量手助腹腔镜组明显低于全腹腔镜组,差异有显著性(P<0.05);术后胃肠功能恢复时间手助腹腔镜组高于全腹腔镜组,差异有显著性(P<0.05);并发症比率、住院时间及住院费用两组间比较差异无显著性(P>0.05);术后疼痛级别手助腹腔镜组高于全腹腔镜组,差异有显著性(P<0.05);切口美容评分全腹腔镜组高于手助腹腔镜组,差异有显著性(P<0.05)。结论手助腹腔镜右半结肠癌根治术在手术时长、术中出血量及术后引流量等方面具有优势,切口美容评分、术后疼痛程度及术后胃肠功能恢复时间全腹腔镜右半结肠癌根治术优于手助腹腔镜术式,对于操作熟练的术者,可优先选用全腹腔镜操作。

【Objective】To compare the clinical outcomes between hand-assistant laparoscopic radical right colectomy and total laparoscopic radical right colectomy. 【Methods】316 patients diagnosed as right colic cancer received hand-assistant laparoscopic radical right colectomy or total laparoscopic radical right colectomy. The operation durations, bleeding volumes, postoperative pain scores, postoperative draining volumes, recovery time of gastrointestinal function, hospitalization time, hospitalization expenses, postoperative complications and cosmetic satisfactory scores were compared between the two approaches. 【Results】The operation duration, bleeding volume, postoperative draining volume in hand-assistant laparoscopic group were lower than total laparoscopic group（P〈0.05）; The recovery time of gastrointestinal function of hand-assistant laparoscopic group was longer than total laparoscopic group（P〉0.05）; The hospitalization time, hospitalization expenses, postoperative complications were no significantly differences between the two groups（P〈0.05）. Postoperative pain scores were higher in hand-assistant group（P〈0.05）. The cosmetic satisfactory scores in total laparoscopic group were higher than in hand assistant laparoscopic group（P〈0.05）.【Conclusion】The operation duration, bleeding volume, postoperative draining volume in hand-assistant laparoscopic radical right colectomy were better than total laparoscopic radical right colectomy. The cosmetic satisfactory scores, recovery time of gastrointestinal function, postoperative pain scores and postoperative complications of total laparoscopic radical right colectomy are better. The total laparoscopic radical right colectomy should be recommended for experienced operators. The hand-assistant laparoscopic radical right colectomy may be selected for patients who need to control the operation time or the cosmetic demand is poor.