腹腔镜右半结肠癌根治术两种入路方法的对照研究

A randomized controlled study of laparoscopic radical resection of right colon cancer by using two different approaches

目的探究腹腔镜右半结肠根治术中头侧中间入路与尾侧中间入路的临床效果。方法选择2017年5月至2019年5月行腹腔镜右半结肠癌根治术患者102例进行前瞻性研究,随机数字法将其分为两组,其中行头侧中间入路51例患者为头侧组,行尾侧中间入路51例患者为尾侧组。采用SPSS24.0进行数据分析,术中血管损伤、术后并发症等计数资料采用χ^2检验;手术相关临床指标、术后临床指标及肿瘤指标用(x±s)表示,采用独立样本t检验,以P<0.05为差异有统计学意义。结果尾侧组在手术时间及术中出血量均优于头侧组(P<0.05)。术中血管损伤、中转开腹、术后并发症、首次排气时间、住院时间、淋巴清扫数目、标本质量比较,两组差异均无统计学意义(P>0.05)。结论两组入路方式均为符合肿瘤根治性手术原则的有效手术入路方式,其手术效果相当。尾侧中间入路在手术时间及术中出血量方面更有优势。

Objective To investigate the clinical outcome of laparoscopic right hemicolectomy by using cephalic-intermediate or caudal-intermediate approach. Methods A prospective study was conducted in 102 patients underwent laparoscopic radical resection of right colon cancer from May 2017 to May 2019. All of 102 patients were randomly divided into two groups, including 51 cases in cephalic group by using cephalic-intermediate approach, while 51 patients cases in caudal group by using caudal-intermediate approach. Statistical analysis were performed by using SPSS 24.0 software package. Count data such as rate of intraoperative vascular injury and postoperative complication were compared by using χ^2 test. Measurement data such as surgical indicators, postoperative clinical indicators and tumor indexs were expressed as (x±s) and examined by using independent t-test. A P value of <0.05 was considered as statistically significant difference. Results The operation time and bleeding volume in caudal group were better than those in cephalic group, with significant difference(P<0.05). There were no significant differences between two groups in terms of intraoperative vascular injury, conversion to laparotomy, postoperative complications, first exhaust time, hospitalization time, number of lymph node dissection and specimen quality(P>0.05). Conclusion By using both two surgical approaches, radical resection of tumors could be achieved effectively in accordance with the principles of, CME. Howerve, using caudal-intermediate approach could help to decrease operation time and intraoperative bleeding volume.