Ⅱ〜Ⅲ期右半结肠癌腹腔镜尾侧对比中间入路手术的围手术期临床疗效研究

Perioperative clinical efficacy of laparoscopic “caudal to cranial” versus“medial to lateral”approach for stage Ⅱ〜Ⅲ right hemicolon cancer

目的比较腹腔镜右半结肠切除尾侧入路和中间入路围手术期临床疗效。方法回顾性分析广东省中医院胃肠肿瘤中心自2015年1月至2016年9月145例Ⅱ〜Ⅲ期右半结肠癌患者的围手术期临床资料,其中尾侧入路法44例(尾侧入路组),中间入路法101例(中间入路组)。比较两组患者的一般资料、术中和术后资料及术后病理资料。结果两组中转开腹情况差异无统计学意义[1/44(2.27%)比5/101(4.95%),P=0.457],但尾侧入路组手术时间长于中间入路组[210.00(180.00,233.75)min比175.00(145.00,220.00)min,P=0.001]。尾侧入路组进食时间短于中间入路组[3.00(2.00,4.00)d比3.00(2.00,5.00)d,P=0.027]。尾侧入路组与中间入路组对比获取总淋巴结和阳性淋巴结数差异无统计学意义。同时尾侧入路组对比中间入路组淋巴血管浸润和癌结节的发生率要高(分别为43.18%比23.76%,22.73%比5.05%;P<0.05)。两组出血量和术后并发症差异无统计学意义。结论两种入路手术方式均安全可行,尾侧入路在术后恢复进食方面存在优势,但开展早期需要更长的手术时间。

Objective To compare the clinical effect of perioperative period between “caudal to cranial”(CC)versus“medial to lateral”(ML)approach for laparoscopic right hemicolectomy.Method Retrospective analysis was made on the perioperative clinical data of 145 patients with stage Ⅱ〜Ⅲ right colon cancer from January 2015 to September 2016 in the Gastrointestinal Tumor Center of Guangdong Hospital of Traditional Chinese Medicine,including 44 patients with CC approach group and 101 patients with ML approach group.The general data,intraoperative and postoperative data and postoperative pathological data of the two groups were compared.Result The CC group showed no statistically significant difference in the conversion rate[(1/44,2.27%)vs.(5/101,4.95%);P=0.457]but a longer operative time[210.00(180.00,233.75)min vs.175.00(145.00,220.00)min(P=0.001)]than the ML group.The time to oral intake was shorter in the CC group than in the ML group[3.00(2.00,4.00)d vs.3.00(2.00,5.00)d(P=0.027)].The median number of total and positive harvested lymph nodes were without statistically significant difference.The rates of lymphatic vascular invasion and cancer nodules were higher in the CC group(43.18%vs.23.76%,22.73%vs.5.05%;P<0.05).There were no differences in blood loss and postoperative complications.Conclusion Both approaches were safe and feasible and resulted in excellent survival.The CC approach was beneficial in terms of rapid recovery after operation,but a longer surgical time was required in the early stages with this technique.