腹腔镜中线入路右半结肠完整系膜切除术治疗右半结肠癌患者的临床研究

Clinical study of laparoscopic oventral line approach for complete mesocolic excision for right hemicolon cancer

目的:探讨开腹与腹腔镜中线入路右半结肠完整系膜切除术(complete mesocolic excision,CME)治疗右半结肠癌的临床疗效。方法:203例右半结肠癌患者,按照手术方式分为观察组(n=102)与对照组(n=101),观察组行腹腔镜中线入路右半结肠CME术,对照组采用传统开腹中线入路右半结肠CME术,对比分析两组的治疗有效率、术中出血量、淋巴结清扫数量、手术时间、术后进食时间、术后排气时间、术后并发症发生率等指标。结果:观察组患者治疗总有效率91.2%,高于对照组的78.2%(P<0.05);观察组术后进食时间、术后排气时间均明显早于对照组,术中出血量少于对照组(P<0.05);观察组淋巴结清扫数量多于对照组(P<0.05);观察组与对照组手术时间比较,差异无统计学意义(P>0.05);观察组术后并发症发生率为3.9%,低于对照组的12.9%,差异具有统计学意义(P<0.05)。结论:腹腔镜中线入路右半结肠CME术治疗右半结肠癌疗效确切,安全性较高,同时创伤较小,术后恢复更快,且术后并发症发生率低,值得临床推广。

Objective:To discuss the clinical effects of laparoscopic oventral line approach for complete mesocolic excision for right hemicolon cancer. Methods:203 patients with right hemicolon cancer were randomly divided into the observation group ( n =101) and the control group ( n =101),the observation group were treated with laparoscopic oventral line approach for complete mesocolic excision (CME),and the control group were treated with traditional laparotomy oventral line approach for CME.The therapeutic efficacy, intraoperative bleeding,number of lymph node dissection,operative time,eating time,exhaust time and incidence of complications were compared and analyzed between the two groups. Results:The total effective rate in the observation group was 91.2%,which was significantly higher than 78.2% in the control group ( P <0.05).The postoperative feeding time,postoperative exhaust time in observation group was significantly earlier than that in control group,and the amount of bleeding during operation was significantly less than that in control group ( P <0.05).Number of lymph node dissection in the observation group was significantly more than the control group ( P <0.05).There was no significantly difference in the operative time ( P >0.05).Postoperative complications in the observation group was 3.9%,which was significantly lower than 12.9% in the control group ( P <0.05). Conclusion:Laparoscopic oventral line approach for CME is effective ,safe,less trauma,faster recovery and lower incidence of complications.It is worthy of clinical promotion.