腹腔镜尾侧入路联合中间翻页式清扫右半结肠癌根治术的临床疗效

Clinical Efficacy of Laparoscopic Caudal Approach Combined with Page-turning Dissection for Radical Resection of Right Colon Cancer

目的探讨腹腔镜尾侧入路联合中间翻页式清扫右半结肠癌根治术的可行性及临床疗效。方法回顾性分析2016年1月至2019年12月广州市红十字会医院普外科收治的120例腹腔镜右半结肠癌手术患者的临床资料,按照手术入路不同分为研究组和对照组,各60例。研究组采用腹腔镜尾侧入路联合中间翻页式清扫,对照组采用传统中间入路法。比较两组患者的一般资料、手术相关指标、术后病理指标、术后恢复情况、随访结果等。结果研究组手术时间短于对照组[185(180,218)min比226(198,240)min]、术中出血量少于对照组[35(30,50)mL比40(31,50)mL](P<0.05)。两组患者肿瘤直径、淋巴结总数、阳性淋巴结数、肿瘤分化程度及病理类型比较差异无统计学意义(P>0.05)。两组患者术后排气时间、住院时间及总并发症发生率比较差异无统计学意义(P>0.05)。研究组和对照组总生存率分别为95.00%(57/60)和,91.67%(55/60),无瘤生存率分别为93.33%(56/60)比88.33%(53/60),两组比较差异无统计学意义(P>0.05)。结论腹腔镜尾侧入路联合中间翻页式清扫行右半结肠癌根治术安全可靠,该入路方式更容易进入正确的解剖层面,有效减少术中出血量,缩短手术时间,患者术后恢复情况及远期预后与传统中间入路相当。

Objective To explore the feasibility and clinical effect of laparoscopic caudal approach combined with page-turning dissection for radical resection of right colon cancer.Methods The clinical data of 120 patients with right colon cancer treated by laparoscopic surgery in Department of General Surgery,Guangzhou Red Cross Hospital from Jan.2016 to Dec.2019 were retrospectively analyzed.According to the different operative approaches,the patients were divided into a research group and a control group,with 60 cases in each group.The research group adopted the laparoscopic caudal approach combined with intermediate page-turning dissection,while the control group adopted the traditional intermediate approach.The general data,operation-related indexes,postoperative pathological indexes,postoperative recovery and follow-up results of the two groups were compared.Results The operation time in the research group was shorter than that in the control group[185(180,218)min vs 226(198,240)min],and the intraoperative bleeding volume was less than that in the control group[35(30,50)mL vs 40(31,50)mL](P<0.05).The tumor diameter,total number of lymph nodes,number of positive lymph nodes,degree of tumor differentiation and pathological types of the two groups were not statistically significantly different(P>0.05).The postoperative exhaust time,hospital stay and total complication rate between the two groups were not statistically significantly different(P>0.05).The overall survival rates were 95.00%(57/60)in the research group and 91.67%(55/60)in the control group,tumor-free survival rate were 93.33%(56/60)and 88.33%(53/60)]respectively,and the differences were not statistically significant(P>0.05).Conclusion Laparoscopic caudal approach combined with intermediate page-turning dissection is safe and reliable for right colon cancer.This approach can more easily enter the correct anatomical level,effectively reduce intraoperative bleeding,and shorten the operation time,while the postoperative recovery and long-term prognosis are comparable to those of the traditional intermediate approach.