3D与2D腹腔镜结肠癌完整结肠系膜切除术的临床对比

Clinical Comparison of 3D and 2D Laparoscopic Complete Colonic Mesenterectomy for Colon Cancer

目的比较3D与2D腹腔镜结肠癌完整系膜切除术的临床效果。方法采用回顾性队列研究方法,收集2016年1月至2017年5月我院收治的108例行结肠癌完整系膜切除术患者的临床资料,其中3D腹腔镜组(60例)和2D腹腔镜组(48例),术者严格按照结肠癌完整系膜切除,遵循无瘤原则。观察两组患者手术情况(手术时间、术中出血量、淋巴结清扫数目)及后恢复情况(术后胃肠功能恢复时间、术后并发症、术后住院时间、住院总费用)。结果①手术情况:两组患者均顺利完成结肠癌完整结肠系膜切除术,无中转开腹。3D组和2D组手术时间分别为(174.47±17.89) min,(183.04±19.67) min,术中出血量分别为(109.92±17.40) m L、(120.83±17.76) m L,差异均有统计学(t=-2.368,-3.210,P<0.05)。3D组和2D组淋巴结清扫数目分别为(18.03±3.45)枚、(17. 29±3. 16)枚,两组比较,差异无统计学意义(t=1. 158,P> 0.05)。②术后恢复情况:3D腹腔镜组和2D腹腔镜组结肠癌患者术后胃肠功能恢复时间分别为(3.00±0.86) d和(3.08±0.79) d,两组比较,差异无统计学意义(t=-0.516,P>0.05)。术后并发症发生率分别为3.34%和2.08%,两组比较,差异无统计学意义。术后住院天数分别为(10.93±2.10) d和(11.56±1.75) d,住院总费用分别为(4.67±0.42)万元和(4.58±0.32)万元,两组患者上述指标比较,差异均无统计学意义(t=-1.661,1.221,P>0.05)。结论 3D与2D腹腔镜在结肠癌完整结肠系膜切除术获得相近临床短期疗效,同时缩短了手术时间、减少了术中出血。

Objective To compare the clinical effect of 3 D and 2 D laparoscopic complete mesenterectomy for colon cancer.Methods A retrospective cohort study was used to collect the clinical data of 108 patients with complete mesenterectomy of colon cancer treated in Nanchong Central Hospital from January 2016 to May 2017,60 cases in 3D laparoscopic group and 48 cases in 2D laparoscopic group.The operation was performed strictly according to the complete mesentery of colon cancer and the principle of non-tumor was followed.The operation condition(operation time,intraoperative bleeding volume,lymph node dissection)and postoperative recovery condition(postoperative gastrointestinal function recovery time,postoperative complications,postoperative hospitalization time and total hospitalization cost)were observed in both groups.Results①Operation condition:the two groups of patients successfully completed colon cancer complete mesorectal resection,no conversion to open.The operative time of 3D group and 2D group were(174.47±17.89)min,(183.04±19.67)min,respectively,and the amount of intraoperative bleeding was(109.92±17.40)mL,(120.83±17.76)mL,significantly different(t=-2.368,-3.210,P<0.05).The number of lymph node dissection in 3D group and 2D group were(18.03±3.45)and(17.29±3.16),respectively,no significant difference between the two groups(t=1.158,P>0.05).②Postoperative recovery condition:The recovery time of gastrointestinal function in 3D laparoscopic group and 2D laparoscopic group was(3.00±0.86)d and(3.08±0.79)d,respectively,no significant difference between the two groups(t=-0.516,P>0.05).The incidence of postoperative complications was 3.34%and 2.08%,respectively,no significant difference between the two groups.Postoperative hospitalization days were(10.93±2.10)days and(11.56±1.75)days,respectively,and the total hospitalization expenses were(4.67±0.42)million yuan and(4.58±0.32)million yuan,respectively.There was no significant difference in the above indexes between the two groups(t=-1.661,1.221,P>0.05).Conclusion 3D and 2D laparoscopy in colon cancer complete mesorectal resection obtained similar clinical short-term efficacy,while shortening the operation time,reducing intraoperative bleeding.