不同切口标本取出在腹腔镜乙状结肠癌根治术中的应用

Application of specimen extraction through two different incisions in laparoscopic radical surgery for sigmoid colon cancer

目的探讨不同切口标本取出在腹腔镜乙状结肠癌根治术中的应用效果。方法选择2020年8月至2023年2月同济大学附属杨浦医院收治的94例乙状结肠癌患者作为研究对象,按照随机数表法分为观察组和对照组各47例。两组患者均行腹腔镜乙状结肠癌根治术,对照组经腹部小切口取出标本,观察组经直肠小切口取出标本。比较两组患者的围术期指标(术中出血量、术后排气时间、下床活动时间、住院时间)和手术标本情况(淋巴结清扫个数、肿瘤直径、肠管切除长度);比较两组患者手术前及术后2 d的疼痛评分(VAS)、睡眠质量评分(PSQI);术后随访1年比较两组患者并发症发生情况。结果观察组患者术中出血量、术后排气时间、下地活动时间、住院时间分别为(30.45±9.34)mL、(2.14±0.32)d、(1.43±0.36)d、(6.46±1.54)d,均短于或少于对照组的(36.35±9.77)m L、(2.67±0.45)d、(2.18±0.53)d、(7.27±1.45)d,差异均有统计学意义(P<0.05);两组患者的淋巴结清扫个数、肿瘤直径、肠管切除长度比较差异均无统计学意义(P>0.05);术后2 d,两组患者的VAS、PSQI评分均较手术前降低,且观察组分别为(3.52±0.44)分、(6.98±1.32)分,明显低于对照组的(5.14±0.47)分、(9.45±1.46)分,差异均有统计学意义(P<0.05);术后随访1年,观察组患者的并发症发生率为10.64%,明显低于对照组的27.66%,差异有统计学意义(P<0.05)。结论经腹部小切口与直肠小切口两种切口标本取出在腹腔镜乙状结肠癌根治术中的应用效果相近,但经直肠小切口取出标本的方式可更好改善患者围术期指标,缓解疼痛、提高预后,安全性更高。

Objective To explore the application effect of specimen extraction through two different incisions in laparoscopic radical surgery for sigmoid colon cancer.Methods Ninety-four patients with sigmoid colon cancer admitted to Yangpu Hospital Affiliated to Tongji University from August 2020 to February 2023 were selected as the study subjects and randomly divided into an observation group and a control group,with 47 cases in each group.Both groups of patients underwent laparoscopic radical resection of sigmoid colon cancer.The specimens were collected through a small abdominal incision in the control group,while those in the observation group were collected through a small rectal incision.The perioperative indicators(intraoperative blood loss,postoperative exhaust time,off-bed activity time,length of hospital stay)and surgical specimen conditions(number of lymph node dissection,tumor diameter,and length of intestinal resection)were compared between two groups of patients.The preoperative and postoperative pain score(Visual Analogue Scale,VAS)and Pittsburgh Sleep Quality Index(PSQI)between the two groups of patients before and 2 days after surgery were compared.The incidence of complications between the two groups of patients after 1 year of postoperative follow-up were compared.Results The intraoperative bleeding volume,postoperative exhaust time,off-bed activity time,and length of hospital stay in the observation group were(30.45±9.34)mL,(2.14±0.32)d,(1.43±0.36)d,and(6.46±1.54)d,which were significantly shorter or less than the control group's(36.35±9.77)mL,(2.67±0.45)d,(2.18±0.53)d,and(7.27±1.45)d(P<0.05).There was no statistically significant difference in number of lymph node dissection,tumor diameter,and length of intestinal resection between the two groups(P>0.05).On the 2nd day after surgery,the VAS and PSQI scores of both groups of patients decreased compared to those before surgery,and the scores in the observation group were(3.52±0.44)points and(6.98±1.32)points,which were significantly lower than the control group's(5.14±0.47)points and(9.45±1.46)points,with statistically significant differences(P<0.05).After one year of postoperative follow-up,the incidence of complications in the observation group was 10.64%,which was significantly lower than the control group's 27.66%(P<0.05).Conclusion The application effect of specimen extraction through small abdominal and rectal incisions in laparoscopic radical surgery for sigmoid colon cancer is similar,but the latter can better improve perioperative indicators,alleviate pain,and improve prognosis in patients,which has the advantages of high safety and is worthy of clinical promotion and application.