摘要
目的探析改良中间入路对腹腔镜右半结肠切除术临床效果、并发症及生活质量的影响。方法选取2014年1月至2017年2月诊治的86例行腹腔镜右半结肠切除的患者资料,根据手术入路方式不同分成两组,侧方入路组和中间入路组,各43例。SPSS21.0统计软件分析数据,术中术后各项指标及右半结肠癌活力指标以(±s)表示,采用独立t检验;术后并发症用χ~2检验,P<0.05为差异有统计意义。结果中间入路组淋巴结清扫数、术中出血量、手术时间为(17.7±3.3)枚、(55.7±36.1)ml、(122.4±25.6)min均优于侧方入路组(P<0.05);术后5 d结肠癌活力指标:中间入路组Xiap、Livi、TK1、Plk1水平均低于侧方入路组(P<0.05);而心理情绪、主观症状、社会活动等生存质量评分则高于侧方入路组,差异有统计学意义(P<0.05);中间入路组术后并发症发生率4.7%与侧方入路组7.0%差异无统计学意义(P>0.05)。结论右半结肠切除术行改良中间入路可提高生存质量与淋巴结清扫率,减轻术后恶性肿瘤的影响。
Objective To explore the clinical outcome of improved medial approach in laparoscopic right hemicolectomy for patients with right colon cancer, including complications and quality of life.Methods From January 2014 and February 2017,clinical data of 86 patients who underwent laparoscopic right hemicolectomy were enrolled into study,including 43 cases in lateral approach group and 43 cases in medial approach group. All data were analyzed by using SPSS 21. 0 software. Perioperative measurement data and tumor index were expressed as( ± s),and were examined by using t test. The postoperative complication rate were analyzed by Chi-square test. A P value < 0. 05 was considered as statistically significant difference. Results The number of harvested lymph nodes,intraoperative bleeding and the operation time of the medial approach group were( 17. 7 ± 3. 3),( 55. 7 ± 36. 1) ml and( 122. 4 ±25. 6) min and were better than those of the lateral approach group respectively( P < 0. 05). 5 d post operation,colon cancer index in the medial approach group were lower than those in the lateral approach group,including Xiap,Livi,TK1 and Plk1( P < 0. 05). In terms of life quality,scores of psychological and emotional status,subjective symptom and social activity in the middle approach group were shown to be higher than those in the lateral approach group,with statistically significant difference( P < 0. 05). The incidence of complications was 4. 7% in the medial approach group and 7. 0% in the lateral approach group,with no statistically significant difference between two groups( P > 0. 05). Conclusion Improved medial approach for right hemicolectomy could improve the patients' quality of life and harvested lymph nodes,and could reduce the impact of postoperative malignant tumor with less postoperative complications.
引文
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