三维高清腹腔镜下右半结肠癌根治术的入路选择及疗效分析

Approach selection and efficacy analysis of three-dimensional high-definition laparoscopic radical resection of right colon cancer

目的 探讨三维高清腹腔镜下右半结肠癌根治术的入路选择及临床疗效。方法 回顾性选取2015年5月至2017年8月间我院收治的96例右半结肠癌患者资料,按照不同入路方式分为侧方入路组和中间入路组,分别54例、42例。应用统计学软件SPSS22.0完成分析。手术相关指标、中位生存期采用(±s)表示,独立样本t检验;并发症发生率及远期预后指标采用四格表χ 2检验;P <0.05为差异有统计学意义。结果 侧方入路组手术时间、术中出血量、排气时间均短于中间入路组(均 P <0.05),两组的镇痛时间、住院时间及淋巴结清扫数目差异均无统计学意义(均 P >0.05)。侧方入路组术后并发症总发生率为3.7%,低于中间入路组的11.9%,而差异无统计学意义( P >0.05)。侧方入路组中转开腹率为3.7%,低于中间入路组的16.7%,差异有统计学意义(χ 2=7.080 ,P <0.05)。两组患者的中位生存期、术后1年复发率及1年生存率的差异均无统计学意义(均 P >0.05)。结论 腹腔镜下右半结肠癌根治术采用侧方入路,可缩短手术时间,降低术中出血量及排气时间,并可有效降低中转开腹率,其预后效果与中间入路相当,值得在右半结肠癌根治术中推广应用。

Objective To investigate the approach selection and clinical efficacy of three-dimensional high-definition laparoscopic radical resection of right colon cancer. Methods From May 2015 to August 2017, clinical data of 96 patients with right colon cancer were analyzed retrospectively. According to different approaches, they were divided into lateral approach group and intermediate approach group, 54 cases and 42 cases, respectively. Data analysis was performed by using statistical software SPSS22.0. Measurement data such as surgical indicators were expressed as (±s) and were examined by independent t test. The incidence of complications, conversion rate and survival rate were examined by chi square test. A P value of <0.05 was considered as statistically significant. Results The operation time, intraoperative blood loss and exhaust time in the lateral approach group were shorter than those in the intermediate approach group repectively ( P <0.05). There were no significant differences in analgesia time, hospitalization time and number of lymph node dissection between the two groups (all P >0.05). The total incidence of complications in the lateral approach group was 3.7%, which was lower than that in the middle approach group (11.9%), however without significant difference ( P >0.05). The conversion rate to open surgery in the lateral approach group was 3.7%, which was lower than that in the intermediate approach group (16.7%), with significant difference (χ 2 = 7.080, P <0.05). There were no significant differences of median survival, 1-year recurrence rate and 1-year survival rate between the two groups (all P >0.05). Conclusion Laparoscopic radical resection of right colon cancer through lateral approach could shorten the operation time, reduce the amount of bleeding and exhaust time, and could effectively reduce the conversion rate to open surgery, with equivalent prognosis as well as the intermediate approach. It is worthy of promotion and application in the radical resection of right colon cancer.