尾侧中间联合入路与传统中间入路腹腔镜右半结肠癌根治术临床对比研究

Dorsal-and-medial hybrid approach versus medial-to-lateral approach in laparoscopic right hemicolectomy with complete mesocolic excision:A prospective comparative study

目的探讨尾侧中间联合入路与传统中间入路腹腔镜右半结肠癌完整结肠系膜切除(CME)的技术优劣。方法前瞻性纳入2017年7月至2018年4月期间于上海交通大学医学院附属瑞金医院胃肠外科(上海市微创外科临床医学中心)行腹腔镜右半结肠癌根治术的病人,根据手术入路分为传统中间入路组(中间组)和尾侧中间联合入路组(尾侧组),并对比两组病人的临床资料(包括基线情况、围手术期相关指标、术后病理情况、CME完成情况等)。结果共纳入75例病人,其中中间组35例,尾侧组40例,两组病人基线水平(除CA19-9外)、围手术期相关指标、术后病理情况等差异均无统计学意义,切除肠管长度(24 cm vs.22 cm)、A线长度(9.8 cm vs.9.4cm)、B线长度(9.0 cm vs.8.5 cm)、切除系膜面积(112.4 cm^2vs.109.0 cm^2)、中位淋巴结清扫数(19枚vs.19枚)、淋巴结清扫合格率(97.1%vs.97.5%)、CME完成率(80%vs.85%)等差异均无统计学意义。肥胖[体重指数(BMI)≥25]为影响CME完成率的独立危险因素(P=0.019)。结论尾侧中间联合入路与传统中间入路腹腔镜右半结肠癌根治术在安全性、可行性、短期疗效、淋巴结清扫彻底性及CME完成质量方面差异均无统计学意义,但仍需更大样本前瞻性随机对照研究(RCT)予以证实。

Objective To compare dorsal-and-medial hybrid approach and medial-to-lateral approach in laparoscopic right hemicolectomy with complete mesocolic excision(CME).Methods Patients undergone laparoscopic right hemicolectomy in Department of Gastrointestinal Surgery in Ruijin Hospital Affiliated to Shanghai Jiaotong University School of Medicine from July 2017 to April 2018 were prospectively included.Patients were divided into two groups:dorsal group and medial group.Clinical and pathological data were collected and compared between the two groups.Results There were 35 patients in medial group and 40 patients in dorsal group.No significant differences were found between the two groups in baseline characteristics,perioperative outcomes and pathological results.No significant difference was found between the two groups in length of bowel(24 cm vs.22 cm),A line distance(9.8 cm vs.9.4 cm),B line distance(9.0 cm vs.8.5 cm),area of mesentery(112.4 cm^2 vs.109.0 cm^2),total lymph node count(19 vs.19),lymph node adequate ratio(97.1%vs.97.5%)and CME ratio(80%vs.85%).Obesity was found to be an independent risk factor of CME ratio(P=0.019).Conclusion Dorsal-and-medial hybrid approach and medial-to-lateral approach are comparable in safety,feasibility and effectiveness in laparoscopic right hemicolectomy with complete mesocolic excision.Randomized clinical trials with larger sample size are needed.