手辅助腹腔镜在横结肠中部癌手术中的临床应用

Clinical application of handassisted laparoscopy in transverse colectomy for middle transverse colon cancer

目的:探讨手辅助腹腔镜在横结肠中部癌手术中的安全性及可行性,评估其临床应用价值.方法:回顾性分析2012-04/2015-04南昌大学第一附属医院胃肠外科确诊为横结肠中部癌并实施根治性横结肠切除术的20例患者临床资料,其中手辅助腹腔镜手术11例,腹腔镜辅助手术9例.对两组患者临床数据及结果进行比较分析.结果:20例患者手术均获成功,无中转开腹,无手术死亡病例.手辅助组手术时间明显短于腹腔镜组(153.6 min±28.1 min vs 190.6min±35.0 min,P=0.017);两组患者在术中出血量(121.8 m L±79.4 m L vs 116.1 m L±78.1 mL)、淋巴结清扫数目(15.4枚±5.4枚vs17.6枚±11.7枚)、术后并发症发生率(9.1%vs 11.1%)、术后首次排气时间(3.1 d±0.7 d vs 2.9 d±0.6 d)及术后住院时间(7.4 d±0.7 d vs 7.8 d±1.1 d)差异均无统计学意义(P>0.05).所有患者均门诊及电话随访2-38 mo,手辅助组患者均成功随访,术后1 mo发生黏连性肠梗阻1例,术后8 mo发生肝转移1例;腹腔镜组患者成功随访8例,其中1例术后2年因腹腔广泛转移死亡.结论:手辅助腹腔镜技术在横结肠中部癌根治性切除术中安全可行,可达到肿瘤根治要求和腹腔镜微创效果,但因病例数较少且随访时间较短,远期疗效有待进一步观察.

AIM： To assess the safety, feasibility and clinical application value of hand-assisted laparoscopy in transverse colectomy for middle transverse colon cancer. METHODS： From April 2012 to April 2015, a total of 20 patients with middle transverse colon cancer underwent radical transverse colon resection at Department of Gastrointestinal Surgery of the First Affiliated Hospital of Nanchang University, of whom 11 underwent hand assisted laparoscopic surgery （HALS）, and 9 underwent laparoscopic-assisted surgery （LAS）. The clinical data of all the patients were retrospectively analyzed and compared between the two groups. RESULTS： All the 20 patients had successful surgery. There was no conversion to open surgery or no operative death. Operative time was significantly shorter in the HALS group than in the LAS group （153.6 min ± 28.1 rain vs 190.6 min ± 35.0 min, P = 0.017）. There were no significant differences between the two groups in blood loss （121.8 mL ± 79.4 mL vs 116.1 mL ± 78.1 mL）, number of lymph nodes harvested （15.4 ± 5.4 vs 17.6 ± 11.7）, rate of postoperative complications （9.1% vs 11.1%）, postoperative exhaust time （3.1 d ± 0.7 d vs 2.9 d ± 0.6 d）, or postoperative hospital stay （7.4 d ± 0.7 d vs 7.8 d ± 1.1 d） （P 〉 0.05）. The patients were followed for 2-38 months. In the HALS group, one patient developed intestinal obstruction at I mo and one patient developed liver metastases at 8 mo. In the LAS group, one patient died of extensive abdominal metastasis. CONCLUSION： The hand-assisted laparoscopic technique is feasible and safe in the radical resection of middle transverse colon cancer. Due to a small number of patients included and short follow-up time in this study, further studies are required.