腹腔镜下肠系膜上动脉优先入路和上静脉入路在右半结肠癌治疗中的对比性研究

Comparative study between laparoscopic approach of superior mesenteric artery priority and superior mesenteric venous priority in treatment of patients with right hemicolon carcinoma

目的探讨对比肠系膜上动脉优先入路法和上静脉入路的腹腔镜手术治疗右半结肠癌的安全性及可行性。方法选择2015年1月至2018年12月于肇庆市第一人民医院手术治疗的右半结肠癌的患者76例,其中男性40例,女性36例;年龄49~66岁,平均年龄50.89岁;体质量指数(BMI)21.78~27.45 kg/m^2,平均BMI 24.79 kg/m^2;病程7~20个月,平均病程10.97个月;病灶位于结肠肝曲23例,升结肠23例,盲肠30例。依据肠系膜上动脉优先入路法及肠系膜上静脉优先入路法行腹腔镜手术根治,将患者分为观察组和对照组,每组38例。记录并分析两组患者所用手术时间、术中出血量、清扫淋巴结数量、阳性淋巴结个数及中转开腹例数;记录并分析两组患者接受手术后恢复排气排便时间、引流时间、引流量、镇痛时间、进食时间及住院时间情况;记录并分析两组患者术后早期肠梗阻、吻合口出血、吻合口瘘等短期并发症。结果两组患者的一般资料比较,差异均无统计学意义(P>0.05);与静脉优先入路方式相比,动脉优先入路方式清扫淋巴结总数和阳性淋巴结个数均显著增多,出血量显著减少(P<0.05);观察组引流时间长,引流量大,与对照组比较,差异有统计学意义(P<0.05);两组所用手术时间、中转开腹率、术后恢复排气和排便时间、镇痛时间、进食时间、住院时间和术后短期并发症总发生率差异均无统计学意义(P>0.05)。结论采用肠系膜上动脉优先入路的腹腔镜手术治疗右半结肠癌,能更彻底地清扫淋巴结从而彻底清除癌症病灶,保证肿瘤的根治程度,减少术后复发率,显著改善患者预后,同时未增加更多的手术风险,安全有效,可行性高。

Objective To compare the safety and feasibility of laparoscopic approach between superior mesenteric artery priority and superior mesenteric venous priority in treatment of right hemicolon carcinoma.Methods From January 2015 to December 2018,a total of 76 patients with right hemicolon carcinoma performed surgery were enrolled,which included 40 males and 36 females,aged 49-66 years old with mean age of 50.89 years old;body mass index(BMI)was 21.78-27.45 kg/m^2 with mean BMI of 24.79 kg/m^2;disease course was 7-20 months with mean of 10.97 months.The lesions were found in 23 cases of hepatic curvature,23 cases of ascending colon and 30 cases of cecum.All of them were divided into 2 groups(n=38)according to laparoscopic approach of superior mesenteric artery priority(observation group)and superior mesenteric venous priority(control group).The operative time,intraoperative blood loss,numbers of lymph nodes dissected,numbers of positive lymph nodes and numbers of transferred to laparotomy in 2 groups were recorded and analyzed.The recovery time of exhaust and defecation,drainage time,drainage volume,analgesia time,feeding time and hospitalization time in 2 groups were recorded and analyzed.The short-term complications such as early intestinal obstruction,anastomotic bleeding and anastomotic fistula between 2 groups were recorded and analyzed.Results There was no significant difference in general data between 2 groups(P>0.05).Compared with control group,the total number of dissected lymph nodes and number of positive lymph nodes in observation group were significantly increased,and blood loss was significantly reduced(P<0.05).The observation group showed significantly longer drainage time and larger drainage volume(P<0.05).There were no significant differences in operation time,transferred to laparotomy rate,recovery time of exhaust and defecation,analgesic time,feeding time,hospitalization time and total incidence of postoperative short-term complications between 2 groups(P>0.05).Conclusion It is demonstrated that laparoscopic approach of superior mesenteric artery priority in treatment of right hemicolon carcinoma could more effectively and thoroughly clean lymph nodes and completely removal lesions,which ensure tumor radical degree,reduce postoperative recurrence and significantly improve prognosis.Meanwhile,this safe,effective and high feasibility strategy do not increase the operative risk.