摘要
目的研究腹腔镜右半结肠癌D3根治术中采用经尾侧联合中线入路与中线入路的效果对比。方法2016年12月~2021年12月我院普外科收治的右半结肠癌病人98例,采用随机数字表法分为两组,每组49例。两组均行腹腔镜右半结肠癌D3根治术,对照组采用中线入路,观察组采用经尾侧联合中线入路。比较两组手术情况(手术时间、术中出血量、淋巴结清扫个数)、术后恢复情况(首次排气时间、首次排便时间、住院时间),分析术前、术后2周肿瘤标志物[癌胚抗原(CEA)、糖类抗原125(CA125)]及胃肠激素[胃泌素(GAS)、胃动素(MTL)]水平,统计术后并发症。结果观察组手术时间(131.58±8.96)分钟、首次排气时间(2.81±0.42)天、首次排便时间(3.42±0.55)天均短于对照组[(142.15±9.51)分钟、(3.54±0.48)天、(3.99±0.61)天](P<0.05);术后2周两组CEA、CA125均降低,且观察组CEA(9.25±1.12)ng/ml、CA125(28.26±2.57)U/ml低于对照组[(15.87±1.56)ng/ml、(35.98±3.13)U/ml](P<0.05);术后2周两组GAS、MTL均降低,但观察组GAS(105.26±9.15)μmol/L、MTL(253.21±14.58)ng/L高于对照组[(100.47±8.24)μmol/L、(244.69±13.25)ng/L](P<0.05);两组并发症总发生率比较,差异无统计学意义(P>0.05)。结论与中线入路相比,经尾侧联合中线入路应用于腹腔镜右半结肠癌D3根治术能缩短手术时间,促进术后恢复,降低肿瘤标志物水平,改善胃肠功能,安全性高。
Objective To study the application effect of combined midline approach and caudal midline approach in laparoscopic right colon cancer D3 radical surgery.Methods From December 2016 to December 2021,98 patients with right colon cancer in general surgery department of Rugao People’s Hospital were randomly divided into two groups with 49 patients in each group.Both groups underwent laparoscopic D3 radical resection of right colon cancer.The control group adopted the midline approach,and the observation group adopted the caudal combined midline approach.The operation indexes(operation time,intraoperative bleeding,number of lymph nodes cleaned)and postoperative recovery indexes(time of first exhaust,time of first defecation,and hospital stay)were compared between the two groups.The levels of tumor markers[carcinoembryonic antigen(CEA),carbohydrate antigen 125(CA125)]and gastrointestinal hormones[gastrin(GAS),motilin(MTL)]before and 2 weeks after the operation were analyzed,and the postoperative complications were counted.Results Operation time[(131.58±8.96)min],first exhaust time[(2.81±0.42)days]and first defecation time[(3.42±0.55)days]in observation group were shorter than those in control group[(142.15±9.51)min,(3.54±0.48)days,(3.99±0.61)days](P<0.05).Two weeks after surgery,CEA and CA125 were decreased in both groups,and CEA[(9.25±1.12)ng/ml]and CA125[(28.26±2.57)U/ml]in observation group were lower than those in control group[(15.87±1.56)ng/ml,(35.98±3.13)U/ml](P<0.05).Two weeks after operation,GAS and MTL were decreased in both groups,but GAS[(105.26±9.15)μmol/L]and MTL[(253.21±14.58)ng/L]in observation group were higher than those in control group[(100.47±8.24)μmol/L,(244.69±13.25)ng/L](P<0.05).There was no significant difference in the total incidence of complications between the two groups(P>0.05).Conclusion Compared with the midline approach,the caudal combined midline approach can shorten the operation time,promote postoperative recovery,reduce the level of tumor markers,improve gastrointestinal function,and have high safety.
作者
丁辉斌
周红飞
DING Huibin;ZHOU Hongfei(Department of General Surgery,Rugao People's Hospital,Jiangsu,Nantong 226500,China)
出处
《临床外科杂志》
2023年第9期869-872,共4页
Journal of Clinical Surgery
关键词
腹腔镜右半结肠癌D3根治术
经尾侧联合中线入路
中线入路
手术指标
术后恢复指标
肿瘤标志物
胃肠激素
并发症
laparoscopic D3 radical resection of right colon cancer
approach via the combined midline at the tail side
middle line approach
surgical indicators
postoperative recovery index
tumor markers
gastrointestinal hormone
complication