腹腔镜技术用于右半结肠癌手术的安全性及入路分析

Clinical analysis of safety and approach in laparoscopic surgery for right colon cancer

目的 探究腹腔镜技术用于右半结肠癌手术的安全性及不同入路的临床效果。方法 回顾性分析2012年5月至2017年5月行右半结肠癌根治术的患者145例资料,根据术式不同分为常规入路组( n =47,采用中间入路),侧方入路组( n =53,采用侧方入路),开腹术组( n =45)。数据采用SPSS20.0软件进行分析,术中术后指标、手术前后免疫指标等采用(±s)描述, F检验;术后并发症χ 2检验,P <0.05差异有统计学意义。结果 侧方入路组患者的出血量、清扫淋巴结数量、排气时间等指标均明显优于开腹组与常规入路组患者( P <0.05),而住院时间、镇痛时间、术后并发症的总发生率等指标明显优于开腹组( P <0.05),但与常规入路组差异无统计学意义( P >0.05);手术时间方面,开腹术组则要显著低于两组入路组( P <0.05)。术后三组患者的免疫指标CD4、CD8、CD4/CD8均较治疗前明显改善( P <0.05),侧方入路组明显优于其他两组( P <0.05)。结论 侧方入路在腹腔镜下右半结肠癌根治术中的临床效果显著,可减少并发症发生,提高免疫功能,安全可靠,值得进一步推广应用。

Objective To investigate the safety of laparoscopic techniques for right colon cancer surgery and to explore the clinical outcomes by using different approaches. Methods A retrospective analysis was performed in 145 patients who underwent radical resection of right colon cancer from May 2012 to May 2017. According to the surgical approach, patients were divided into routine approach group ( n =47, intermediate approach), into lateral approach group ( n =53, lateral approach) and open surgery group ( n =45). The data were analyzed by using SPSS20.0 software. Measurement data such as perioperative relevant indicators and immune function indicators were expressed as (±s) and were examined by independent F test. The incidence of complications were examined by chi square test. A P value of <0.05 was considered as statistically significant. Results The amount of bleeding, the number of lymph nodes, and the time of exhaustion in the lateral approach group were significantly better than those in the open group and the routine approach group respectively( P <0.05). Hospitalization time, analgesia time and the total incidence of complications in the lateral approach group were significantly better than those of the open group respectively ( P <0.05), however there was no significant difference between routine approach group ( P >0.05). In terms of operation time, the open surgery group was significantly lower than the other two groups ( P <0.05). After treatment, the immune indexes such as CD4, CD8, CD4/CD8 of the three groups were significantly improved ( P <0.05). The indexes of patients in the lateral approach group were significantly better than the other two groups ( P <0.05). Conclusion The clinical effect of lateral approach in laparoscopic radical resection of right colon cancer is remarkable, which could reduce complications and improve immune function. It is safe and reliable and worthy of further promotion and application.