完全腹腔镜根治性右半结肠切除术在老年结肠癌患者应用中的前瞻性研究

Totally laparoscopic right colectomy for colon cancer in elderly patients:a prospective study

目的探讨老年结肠癌患者行完全腹腔镜根治性右半结肠切除术的安全性、可行性。方法前瞻性选择2017年2月~2018年11月我院收治的80例老年右半结肠癌患者,按照随机数字表法分成两组,观察组患者采用完全腹腔镜根治性右半结肠切除术,对照组患者采用腹腔镜辅助根治性右半结肠切除术。比较两组患者的基线情况、术前ASA分级、术前肿瘤分期(TNM)、手术指标、术后指标、术后并发症等。结果两组患者间年龄、性别、体质指数、术前合并症、ASA分级、TNM分期,差异均无统计学意义(P>0.05)。两组患者间手术时间、术中出血量、术后淋巴结数、标本长度、住院时间,差异均无统计学意义(P>0.05)。观察组、对照组术后切口长度分别为(4.2±0.8vs5.9±0.7)cm,差异有明显统计学意义(P<0.00)。观察组术后肠功能恢复时间、首次流质饮食时间均早于对照组(2.5±1.4vs3.2±1.3)d、(2.6±1.4vs3.2±1.4)d,差异均有统计学意义(P<0.05)。观察组、对照组术后并发症的发生率分别为(12.5%vs15.0%),差异无统计学意义(P>0.05)。结论老年结肠癌患者行完全腹腔镜根治性右半结肠切除术是安全、可行的,并可获得更好的术后恢复。

Objective To investigate the safety,feasibility of totally laparoscopic right colectomy (TLRC)in elderly patients with colon cancer.Methods Eighty elderly patients with right-sided colon cancer from February 2017 to November 2018 were randomized into the observation group and the control group.Patients in the observation group were assigned to undergo totally laparoscopic right colectomy(TLRC),Patients in the control group were assigned to undergo laparoscopic-assisted right colectomy(LARC).The terms of demography,American Society of Anesthesiologists(ASA)classification, preoperative stage distribution(TNM),details of operations,post-operative recovery,and postoperative complications were recorded and analyzed.Results No significant differences were found among preoperative clinical data(P>0.05).There were no significant differences among the groups in terms of average operative time,blood loss,lymph node harvest,specimen length,time to hospital stay(P>0.05). There were significant differences in the length of minilaparotomy between the observation group and the control group(4.2±0.8 vs 5.9±0.7 cm,P<0.00).Timing of first flatus(2.5±1.4 vs 3.2±1.3 d,P<0.05)and time to liquid diet(2.6±1.4 vs 3.2±1.4 d,P<0.05)were statistically lower in observation group.There were no significant differences between the two groups for postoperative complications(12.5% vs 15.0%, P>0.05).Conclusion TLRC in elderly patients with colon cancer is safe and feasible,and is better in post-operative recovery.