摘要
背景与目的:随着对关键解剖标志、手术层面及完整结肠系膜切除理念等认识的深入,腹腔镜右半结肠切除手术技术日益成熟,淋巴结清扫范围及消化道重建方式逐步规范。选择合适的手术入路对规范淋巴结清扫范围、寻找正确解剖平面以及减少术中并发症同样具有重要意义。本研究探讨头尾侧联合手术入路行腹腔镜右半结肠癌根治术的可行性及安全性,以期进一步提高该手术的疗效与成功率。方法:回顾性分析2014年11月-2018年11月期间湖南省郴州市第一人民医院胃肠肿瘤外科120例行腹腔镜右半结肠癌根治术患者的临床资料,其中68例术中采用头尾侧联合入路(观察组),52例采用传统中间入路(对照组)。比较两组患者的相关临床指标。结果:两组患者术前基线资料均无统计学差异(均P>0.05)。观察组的平均手术时间较对照组明显缩短(110.9 min vs.150.9 min,P<0.05)、平均术中出血量较对照组明显减少(25.5 mL vs.50.8 mL,P<0.05),但两组在淋巴结清扫总数、手术标本质量,术后首次排气时间、术后住院时间及并发症发生率方面差异均无统计学意义(均P>0.05)。进一步行亚组分析显示,无论在肥胖或肿瘤位于结肠肝曲的患者中,观察组除了手术时间与术中出血量方面优于对照组外,术后排气时间也明显优于对照组(均P<0.05)。结论:头尾侧联合入路腹腔镜右半结肠癌根治术安全、可行,随着腹腔镜设备广泛普及和器械不断改进,加之腹腔镜技术的推广及手术经验的不断积累,可进一步在临床中推广应用。
Background and Aims:With the deepening of the understanding of key anatomical markers,surgical level and the concept of complete mesocolectomy,laparoscopic right hemicolectomy is becoming increasingly mature,and the scope of lymph node dissection and digestive tract reconstruction are gradually standardized.The selection of appropriate surgical approach is also of great significance for standardizing the scope of lymph node dissection,finding the correct anatomical plane and reducing intraoperative complications.This study was performed to evaluate the feasibility and safety of laparoscopic right radical hemicolectomy for colon cancer using combined craniolateral and caudolateral approach,so as to further improve the efficacy and success rates of this operation.Methods:The clinical data of 120 patients undergoing laparoscopic right radical hemicolectomy for right colon cancer in the Chenzhou First People’s Hospital from November 2014 to November 2018 were retrospectively analyzed.Of the patients,68 cases underwent operation via combined craniolateral and caudolateral approach (observation group),and 52 cases underwent operation via the traditional medial approach (control group).The main clinical variables between the two groups of patients were compared.Results:There were no significant differences in the baseline data between the two groups of patients (all P>0.05).In observation group versus control group,the average operative time was significantly shortened(110.9 min vs.150.9 min,P<0.05) and the average intraoperative blood loss was significantly reduced (25.5 mL vs.50.8 mL,P<0.05),but no significant differences were noted in the total number of lymph node dissection,quality of surgical specimens,time to the first postoperative gas passage,length of postoperative hospital stay and incidence of complications (all P>0.05).Further subgroup analysis showed that either in patients with obesity or patients with tumor of hepatic flexure of the colon,observation group was superiority to control group not only in operative time and intraoperative blood loss,but also in the time to first postoperative gas passage (all P<0.05).Conclusion:Laparoscopic radical resection of right colon cancer through combined craniolateral and caudolateral approach is safe and feasible.With the widespread use of laparoscopic equipment and continuous improvement of instruments,the popularization of laparoscopic technology and the accumulation of surgical experience,it can be further promoted to be used in clinical practice.
作者
杨熙华
罗吉辉
肖方涛
郭仪
YANG Xihua;LUO Jihui;XIAO Fangtao;GUO Yi(Department of Oncological Surgery,Chenzhou First People’s Hospital,Chenzhou,Hunan 423000,China)
出处
《中国普通外科杂志》
CAS
CSCD
北大核心
2020年第4期391-399,共9页
China Journal of General Surgery