腹腔镜下不同入路手术治疗右半结肠癌的临床效果

Clinical effect of different approaches under laparoscopy in the treatment of right colon cancer

目的探讨腹腔镜下不同入路手术方法治疗右半结肠癌患者的有效性以及安全性。方法选取2018年1月至2020年12月枣庄矿业集团中心医院收治的40例右半结肠癌患者作为研究对象,采用随机数字表法将其分为常规组和研究组,每组各20例。常规组患者采用腹腔镜下中间入路手术方式完成治疗,研究组患者采用腹腔镜下回字型右下入路手术方式完成治疗。比较两组患者术中、术后相关指标(淋巴结清扫数量、术中失血量、手术时间、术后排气时间以及住院时间);比较两组患者手术前后的癌胚抗原(CEA)、肿瘤特异性生长因子(TSGF)水平;比较两组患者术后并发症(吻合口漏、肠梗阻、切口感染、腹腔感染、尿路感染)总发生率。结果研究组患者的淋巴结清扫数量为(27.39±5.75)枚,多于常规组的(19.23±5.63)枚,术中失血量为(50.86±9.89)ml,少于常规组的(67.85±8.95)ml,手术时间为(133.29±21.03)min,术后排气时间为(2.75±0.31)d,住院时间为(10.76±2.36)d,均短于常规组的(173.35±19.29)min、(3.31±0.29)d以及(17.31±2.51)d,差异有统计学意义(P<0.05)。术前,研究组患者的CEA水平为(17.85±2.12)μg/L,TSGF水平为(77.86±3.26)U/ml,与常规组的(17.91±1.99)μg/L、(78.03±3.11)U/ml比较,差异无统计学意义(P>0.05);术后,研究组患者的CEA水平为(10.02±1.39)μg/L,TSGF水平为(72.21±1.63)U/ml,与常规组的(10.23±1.43)μg/L、(72.22±1.72)U/ml比较,差异无统计学意义(P>0.05);两组患者术后的CEA、TSGF水平均低于术前,差异有统计学意义(P<0.05)。研究组患者的术后并发症总发生率(5.00%)低于常规组(50.00%),差异有统计学意义(P<0.05)。结论与腹腔镜下中间入路手术方式比较,腹腔镜下回字型右下入路手术方式治疗右半结肠癌患者,可显著改善患者术中、术后系列指标,并降低并发症发生率,可促进右半结肠癌患者的总体预后水平提升。

Objective To investigate the efficacy and safety of different laparoscopic approaches in the treatment of patients with right colon cancer.Methods From January 2018 to December 2020,40 patients with right colon cancer who were admitted to the Central Hospital,Zaozhuang Mining Group were selected as the research subjects.They were divided into a routine group and a study group by the random number table method,with 20 cases in each group.The patients in the routine group were treated by laparoscopic intermediate approach,the patients in the study group were treated by the laparoscopic lower right approach in“Hui”(Chinese character)type.Intraoperative and postoperative indexes(number of lymph nodes dissection,intraoperative blood loss,operation time,postoperative exhaust time and hospital stay)were compared between the two groups.The levels of carcino-embryonic antigen(CEA)and tumor supplied group of factors(TSGF)before and after surgery were compared between the two groups.The total incidence of postoperative complications(anastomotic leakage,intestinal obstruction,incision infection,abdominal infection and urinary tract infection)was compared between the two groups.Results The number of lymph node dissection in the study group was(27.39±5.75),more than that in the conventional group of(19.23±5.63),the intraoperative blood loss was(50.86±9.89)ml,less than that in the conventional group of(67.85±8.95)ml,the operative time was(133.29±21.03)min,postoperative exhaust time and hospitalization time were(2.75±0.31)d and(10.76±2.36)d,both of which were shorter than(173.35±19.29)min,(3.31±0.29)d and(17.31±2.51)d in the conventional group,and the differences were statistically significant(P<0.05).Before surgery,CEA level of the study group was(17.85±2.12)μg/L,TSGF level was(77.86±3.26)U/ml,compared with the conventional group of(17.91±1.99)μg/L and(78.03±3.11)U/ml,the differences were not statistically significant(P>0.05).After surgery,CEA level in study group was(10.02±1.39)μg/L,TSGF level was(72.21±1.63)U/ml,compared with the conventional group of(10.23±1.43)μg/L and(72.22±1.72)U/ml,the differences were not statistically significant(P>0.05).After surgery,CEA and TSGF levels in the groups were lower than those before surgery,and the differences were statistically significant(P<0.05).The total incidence of postoperative complications in the study group(5.00%)was lower than that in the conventional group(50.00%),and the difference was statistically significant(P<0.05).Conclusion Laparoscopic lower right approach in"Hui"type is effective.Compared with laparoscopic intermediate approach,it can significantly improve the patients′intraoperative and postoperative indicators,reduce the incidence of complications,and promote the overall prognosis of patients with right colon cancer.