头侧混合入路与尾侧入路腹腔镜右半结肠切除术围术期指标的观察

Observation of perioperative indices of laparoscopic right hemicolectomy with cephalic mixed approach and caudal approach

目的观察对比腹腔镜右半结肠切除术头侧混合入路与尾侧入路的围手术期指标。方法回顾性队列研究。纳入2019年12月—2022年12月长治医学院附属和济医院胃肠外科收治的67例行腹腔镜右半结肠切除术的右半结肠癌患者,其中男34例、女33例,年龄27~81(60.4±12.7)岁。按手术入路分为2组:头侧混合入路组35例,其中男17例、女18例,年龄27~68(59.3±12.0)岁,尾侧入路组32例,其中男17例、女15例,年龄30~81(61.7±13.5)岁。比较2组患者临床基线资料和围手术期指标(手术时间、术中出血量、淋巴结清扫数目以及术后并发症的发生率)。结果2组患者性别、年龄、体质量指数、肿瘤TNM分期等基线资料比较,差异均无统计学意义(P值均>0.05)。2组患者手术均顺利。头侧混合入路组手术时间为(155±27)min,短于尾侧入路组的(245±31)min,头侧混合入路组的术中出血量为(53±6)mL,少于尾侧入路组的(90±10)mL:组间比较差异均有统计学意义(t=12.78、3.32,P值均<0.05)。头侧混合入路组和尾侧入路组的术中淋巴结清扫数分别为(16±2)枚和(20±3)枚,术后首次排气时间分别为(5.2±0.8)d和(5.5±1.3)d,术后首次进食时间分别为(6.7±0.8)d和(7.2±1.7)d,术后住院时间分别为(11.3±1.9)d和(12.0±3.3)d,术后并发症发生率分别为11.4%(4/35)和18.8%(6/32),组间比较差异均无统计学意义(P值均>0.05)。结论与尾侧入路相比,头侧混合入路在腹腔镜右半结肠切除术中手术时间短、术中出血量少,对于患者更安全。

Objective This study aimed to observe the perioperative indices of mixed cephalic approach and caudal approach in laparoscopic right colectomy.Methods This study was a retrospective cohort study.Clinical data of 67 patients with right half colon cancer who underwent laparoscopic right hemicolectomy in the Department of Gastrointestinal Surgery,Heji Hospital Affiliated to Changzhi Medical College from December 2019,to December 2022,were analyzed retrospectively.The patient were 27−81(60.4±12.7)years old,34 were males,and 33 were females.In accordance with the surgical approach,the patients were divided into cephalic mixed approach group(n=35)and caudal approach group(n=32).The cephalic mixed approach group consisted of 17 males and 18 females aged 27−68(59.3±12.0)years,and the caudal approach group was composed of 17 males and 15 females aged 30−81(61.7±13.5)years.The clinical baseline data and perioperative indicators(including operation time,intraoperative blood loss,number of lymph node dissection,and postoperative complications)between the two groups were compared.Results No significant difference was found in the baseline data,such as gender,age,body mass index,and clinical TNM staging,between the two groups(all P values>0.05).The operation was successfully conducted in both groups.The operative time of the cephalic mixed approach group was(155±27)min,which was shorter than that of the caudal approach group(245±31)min.The intraoperative blood loss of the cephalic mixed approach group was(53±6)mL,which was lower than that of the caudal approach group(90±10)mL,with significant difference(t=12.78,3.32,all P values<0.05).The numbers of intraoperative lymph nodes dissection were 16±2 in the cephalic mixed approach group and 20±3 in the caudal approach group.The first exhaust time of the cephalic mixed approach group and the caudal approach group were(5.2±0.8)and(5.5±1.3)days,respectively.The first feeding time were(6.7±0.8)days in the cephalic mixed approach group and(7.2±1.7)days in the caudal approach group.The postoperative hospital stay of the cephalic mixed approach group was(11.3±1.9)days,and that of the caudal approach group was(12.0±3.3)days.Four patients had postoperative complications of the cephalic mixed approach group(11.4%,4/35),and six patients had postoperative complications of the caudal approach group(18.8%,6/32).No significant difference was found between the two groups(all P values>0.05).Conclusion The cephalic mixed approach is safer than the caudal approach because of shorter operation time and less bleeding during laparoscopic right hemicolectomy.