不同入路在腹腔镜结直肠癌手术中结肠脾曲游离的临床效果

Clinical effect of different approaches in colonic splenic flexure dissociation in laparoscopic colorectal cancersurgery

目的探讨不同入路在腹腔镜结直肠癌手术中结肠脾曲游离的临床效果。方法前瞻性选取2018年1月至2020年12月结直肠癌患者116例,采用随机数字表法将患者分为对照组和研究组,每组各58例。两组患者均行腹腔镜结直肠癌根治术,对照组:采用传统的侧方入路手术,研究组:采用中间入路“四步法”手术。数据应用软件SPSS22.0处理。围手术期相关指标等计量资料采用(x±s)表示,行独立样本t检验;并发症情况等计数资料行×^(2)检验;生存分析采用Kaplan-Meier法,行Log-Rank检验。P<0.05为差异有统计学意义。结果研究组患者手术时间、术中出血量、术后排气时间、恢复流质饮食时间及术后住院时间均较对照组均显著减少,淋巴结清扫数目显著增多,差异均有统计学意义(P<0.05)。研究组总并发症发生率显著较对照组低(6.9%us.20.7%,P<0.05)。患者术后随访5~41个月,中位随访时间28个月,两组患者累积总生存率及无病生存率比较差异无统计学意义(P>0.05)。结论腹腔镜结直肠癌根治术中结肠脾曲游离采用中间入路“四步法”,不仅具有手术时间缩短、术中出血少、术后恢复快、淋巴结清扫更彻底等优势,还可以有效降低并发症发生的风险,手术安全性更高。

Objective To investigate the Clinical effect of different approaches in laparoscopic colorectal cancer surgery.Methods116 cases of colorectal cancer patients in our hospital from January 2018 to December 2020 were selected.The patients were divided into control group and study group according to random number table,each of 58 cases.Laparoscopic radical resection of colorectal cancer was performed in both groups,the control group was treated with traditional lateral approach,and the study group was treated with“four-step”technique through the middle approach.The data were processed by SPSS 22.0.The measurement data of perioperative related indicators were expressed by(xs),and independent t test was performed;Complication count column ×^(2) inspection;Kaplan-Meier method and Log-Rank test were used for survival analysis.P<0.05 was statistically significant.ResultsCompared with the control group,the perioperative operation time,intraoperative blood loss,postoperative exhaust time,recovery of fluid diet time and postoperative hospital stay of the study group were significantly reduced,and the number of lymph node dissection was significantly increased,with statistically significant differences(P<0.05).The incidence of total complications in the study group was significantly lower than that in the control group(6.9%us.20.7%,P<0.05).Postoperative follow-up was 5~41 months,with a median fllow-up of 28 months.There was no statistical significance in cumulative overall survival and disease-free survival between the two groups(P>0.05).ConclusionThe application of the middle approach“four-step method”in the separation of splenic curvature of colon in laparoscopic radical resection of colorectal cancer not only has the advantages of short operation time,less intraoperative bleeding,quick postoperative recovery and more thorough lymph node dissection,but also can effectively reduce the risk of complications,and the safety of the operation is higher.