腹腔镜右半结肠癌完整系膜切除术经尾侧-中间联合入路回顾性研究

A retrospective study on laparoscopic complete mesocolic excision via dorsal-medial hybrid approach for right colon cancer

目的 :比较腹腔镜右半结肠癌完整系膜切除术(complete mesocolic excision, CME)经尾侧-中间联合入路(简称尾侧联合入路)与传统中间入路(简称中间入路)在手术学、肿瘤学等方面的效果。方法 :回顾性分析2017年1月至6月收治的68例右半结肠癌病人。根据手术入路分为尾侧联合入路组37例及中间入路组31例。采用West分级系统评估比较两组的CME完成质量以及手术安全性、术后近期疗效及远期预后。结果:病人均经CME完成质量评估。尾侧联合入路组CME完成率为86.5%,中间入路组CME完成率为80.6%。两组间差异无统计学意义(P=0.53)。尾侧联合入路组腹腔镜下解剖时间较中间入路缩短[(62.70±12.22) min比(70.39±11.98) min,P=0.01]。两组病人总手术时间、术中出血量、术后排气时间、术后并发症发生及远期预后差异均无统计学意义。结论:腹腔镜右半结肠癌CME,经尾侧联合入路可缩短腹腔镜下解剖时间,CME完成质量、安全性、预后两种手术入路相当。

Objective To investigate pathologic effects combined with postoperative results on right colon cancer with laparoscopic complete mesocolic excision(CME)via dorsal-medial hybrid approach compared with traditional medial approach.Methods A total of 68 patients with right colon cancer undergoing laparoscopic CME in our hospital between January and June 2017 were studied retrospectively.There were two groups including 37 cases in dorsal-medial hybrid group and 31 cases in traditional medial group.CME quality evaluated with the method proposed by West et al along with safety,short-term results and long-term prognosis were compared between two groups.Results CME completion rate was 86.5%in dorsal-medial hybrid group and 80.6%in traditional medial group without statistical difference(P=0.53).Laparoscopic dissection time in dorsal-medial group was significantly shorter than that in traditional medial group[(62.70±12.22)min vs.(70.39±11.98)min,P=0.01].There was no statistical difference in operation time,blood loss,postoperative flatus time,postoperative complications and long-term prognosis of the patients between two groups.Conclusions Laparoscopic CME via dorsal-medial hybrid approach for right colon cancer could have less laparoscopic dissection time,and two approaches were similar in CME quality,safety and prognosis.