腹腔镜下两种入路右半结肠癌根治术的对比研究

A Comparative Study of Laparoscopic Radical Resection of Right Colon Cancer with Two Approaches

目的分析两种不同入路法在腹腔镜下右半结肠癌根治术中临床应用效果及对机体免疫的影响。方法回顾性分析2016年1月至2021年12月48例行腹腔镜右半结肠癌根治术患者的临床资料,按手术入路分为两组,分别是观察组24例(尾侧入路联合中间翻页式清扫)和对照组24例(中间入路),比较两组患者的一般资料(性别、年龄、BMI、肿瘤直径、TNM分期)、手术相关指标(手术时间、术后首次排气时间、术后住院时间、切除标本长度、术中出血量、术中淋巴结清除数、术后并发症发生率)以及手术前后炎性反应指标(白细胞计数、C-反应蛋白)、肿瘤标志物(CEA)及免疫指标(CD_(4)^(+)/CD_(8)^(+))的变化。结果观察组患者手术时间、术中出血量均少于对照组,手术后第7天的CD_(4)^(+)/CD_(8)^(+)比值比对照组高,差异显著(P<0.05);而两组患者术后首次排气时间、术后住院时间、术中淋巴结清扫数、切除标本长度、并发症发生率以及手术前后白细胞计数、C-反应蛋白、CEA水平差异均无统计学意义(P>0.05)。结论两种入路法治疗右半结肠癌均安全有效,但相较于中间入路,尾侧入路联合翻页式清扫法在右半结肠癌根治术中具有手术时间短及术中出血量少的优势,对患者免疫影响相对较小。

Objective To compare and analyze the clinical effect of two kind of approaches in laparoscopic radical resection of right colon cancer.Methods The data of 48 patients undergoing laparoscopic radical resection of right colon cancer from January 2016 to December 2021 were retrospectively analyzed.According to the different operative approaches,the patients were divided into two groups:the observation group(n=24,caudal approachc ombined with middle leaf turning sweep was used)and the control group(n=24,intermediate approach was used).Compare and analyze the general data(sex,age,BMI,tumor diameter and TNM stage),and operation-related date(operation time,postoperative first exhaust time,hospitalization time after operation,resection specimen length,intraoperative bleeding,number of lymph node dissection,postoperative complication rate),the date of inflammatory response index before and after surgery(white blood cell count,C-reactive protein),the date of tumor markers(CEA)and the date of immune index(CD_(4)^(+)/CD_(8)^(+)).Results The operation time and intraoperative bleeding volume of the patients in the observation group were less than that in the control group,the ratio of the postoperative CD_(4)^(+)/CD_(8)^(+) was higher than that in the control group(P<0.05).There were no significant differences in the postoperative first exhaust time,the time of hospitalization after operation,number of lymph node dissection,resection specimen length,complication rate,the date of inflammatory response index before and after surgery white blood cell count,C-reactive protein,and CEA(P>0.05).Conclusion The caudal approach combined with pageturning dissection has the advantage of short operation time and less intraoperative bleeding in the right half of colon cancer,the impact on patient immunity is relatively small,and both procedures are safe and effective for right colon cancer.The caudal approach has the advantages of short operative time and less blood loss during radical resection of right hemicolon cancer.Both methods are safe and effective for treating right hemicolon cancer.