主刀中间站位改良五孔法在腹腔镜下右半结肠切除术的效果

Efficacy of Modified Five-Port Method with Middle Position of Surgeon in Laparoscopic Right Hemicolectomy

目的研究主刀中间站位改良五孔法对比常规五孔法在腹腔镜下右半结肠切除术的临床疗效。方法回顾性分析2018年11月至2021年11月于南昌大学第二附属医院72例接受腹腔镜辅助右半结肠癌根治术患者的临床资料。其中观察组(33例)采用主刀中间站位改良五孔法腹腔镜手术,对照组(39例)采用常规五孔法腹腔镜手术,均为同一主刀医师手术。比较2组患者围手术期相关指标(手术时间、术中出血量、清扫淋巴结数、术后首次通气时间、住院时间)和2组术后并发症(切口感染、吻合口瘘、肠梗阻、肺部感染)及术后1年复发或转移情况。结果72例患者手术均顺利完成,无中转开腹,术后均痊愈出院。观察组手术时间、术中出血量少于对照组,清扫淋巴结数多于对照组(P<0.05);2组首次排气时间、住院时间比较差异无统计学意义(P>0.05)。2组患者术后切口感染、吻合口瘘、肠梗阻发生率比较差异无统计学意义(P>0.05);观察组肺部感染和并发症总发生率低于对照组(P<0.05)。排外术后病理分期为Ⅳ期患者后,观察组病例数29例,对照组32例。术后随访1年,观察组出现肝转移1例[3.45%(1/29)],对照组出现转移3例[9.38%(3/32),其中肝转移2例,网膜/腹壁种植转移1例],2组比较差异无统计学意义(P>0.05)。结论在腹腔镜辅助右半结肠癌根治性切除术中,相比常规五孔法,改良五孔法临床疗效及安全性均更优。

Objective To compare the clinical efficacies of modified five-port method with middle position of surgeon and conventional five-port method in laparoscopic right hemicolectomy.Methods Clinical data of 72 patients who underwent laparoscopic right hemicolectomy in the Second Affiliated Hospital of Nanchang University from November 2018 to November 2021 were retrospectively analyzed.Among these patients,33 received modified five-port laparoscopic surgery with middle position of surgeon(observation group),and 39 underwent conventional five-port laparoscopic surgery(control group).All the operations were performed by the same surgeon.Perioperative parameters(operation time,intraoperative blood loss,number of lymph nodes dissected,time to first flatus and length of hospital stay),postoperative complications(incisional infection,anastomotic fistula,intestinal obstruction and pulmonary infection),and recurrence or metastasis 1 year after surgery were compared between the two groups.Results All operations were successfully completed without conversion to laparotomy,and all patients were cured and discharged from hospital after operation.Compared with the control group,the operation time,intraoperative blood loss,pulmonary infection rate and total complication rate were reduced and the number of lymph nodes dissected was increased in the observation group(P<0.05).There were no significant differences between the two groups in the time to first flatus,length of hospital stay,and incidence of incisional infection,anastomotic fistula and intestinal obstruction(P>0.05).After excluding the patients with stageⅣcancer,there were 29 cases in the observation group and 32 cases in the control group.After 1 year follow-up,a patient(3.45%)in the observation group had liver metastasis,and 3 cases(9.38%)in the control group had metastasis(2 cases of liver metastasis and 1 case of omentum/abdominal wall implantation metastasis).There was no significant difference in the incidence of metastasis between the two groups(P>0.05).Conclusion The modified five-port method is more effective and safer than conventional five-port method in laparoscopic right hemicolectomy.