改良中间入路对腹腔镜右半结肠切除术临床效果观察
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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.
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
[1]池畔,李国新,杜晓辉,主编.腹腔镜结直肠肿瘤手术学[M].北京:人民卫生出版社,2013:116-121.
[2]肖毅.腹腔镜右半结肠癌CME手术技巧[J/CD].中华普外科手术学杂志(电子版),2017,11(2):99-101.
[3]Lazovic R,Radojevic N,Curovic I.Performance of primary repair on colon injuries sustained by low versus high-energy projectiles[J].Journal of Forensic and Legal Medicine,2016,39:125-129.
[4]Ren W,Shen S,Sun Z,et al.Jak-STAT3 pathway triggers DICER1for proteasomal degradation by ubiquitin ligase complex of CUL4A DCAF1 to promote colon cancer development[J].Cancer Letters,2016,375(2):209-220.
[5]史建中,钱山青,孙卫东,等.中间入路法腹腔镜右半结肠癌根治术55例临床体会[J].腹腔镜外科杂志,2016,21(10):742-744.
[6]刘广宝.手助腹腔镜下右半结肠癌根治术不同手术入路的临床疗效对比[J].中国现代普外科杂志,2014,17(6):462-464.
[7]池畔,官国先.不断提高腹腔镜右半结肠癌根治术规范化水平[J/CD].中华普外科手术学杂志(电子版),2017,11(2):91-94.
[8]王宪中,赵迎威,闫锋.大肠癌致肠梗阻的外科处理方法[J].临床研究,2016,24(7):79-79.
[9]李炳,陈卫兵,王寿青,等.腹腔镜诊治复杂型肠旋转不良七例[J].中华小儿外科杂志,2015,36(11):829-832.
[10]孙跃明.腹腔镜右半结肠癌根治术难点与关键技术[J/CD].中华普外科手术学杂志(电子版),2017,11(2):102-104.
[11]阮振兴,孙敏,李双喜.腹腔镜下不切断空肠的胆肠吻合术(Uncut Roux-en-Y)的临床应用[J].中国微创外科杂志,2016,16(6):514-517.
[12]冯士春,唐翀,袁荣华,等.腹腔镜右半结肠完整系膜切除术手术路径的探讨[J].中华普通外科杂志,2016,31(3):247-248.
[13]廖亮,王薇,许乐,等.孤立性右半结肠缺血性结肠炎预后分析[J].中华老年多器官疾病杂志,2015,14(5):326-328.
[14]邹嘹南,熊文俊,李洪明,等.尾侧人路腹腔镜右半结肠癌根治术疗效分析[J].中华胃肠外科杂志,2015,18(11):1124-1127.
[15]闫峰,白利平,王振发,等.腹腔镜辅助经自然腔道取出标本的结肠次全切除术治疗结肠冗长症[J].中华胃肠外科杂志,2016,19(8):952-955.
[16]Lien GS,Lin CH,Yang YL,et al.Ghrelin induces colon cancer cell proliferation through the GHS-R,Ras,PI3K,Akt,and m TOR signaling pathways[J].European Journal of Pharmacology,2016,776:124-131.
[17]秦绍岚,俞旻皓,慕逸飞,等.全结肠系膜切除术在右半结肠癌根治术中应用的疗效[J].中华胃肠外科杂志,2016,19(10):1101-1106.
[18]郝云鹤,王连臣,候本新,等.腹腔镜下不同入路行右半结肠癌根治术临床疗效观察[J].海南医学,2015,26(17):2598-2560.
[19]王晓斌.腹腔镜辅助下右半结肠癌根治术不同入路效果分析[J].当代医学,2014,20(9):8-9.
[20]黄勇波,张成雷,洪新凯,等.无腹部辅助切口腹腔镜改良经肛门结肠肛管吻合术治疗超低位直肠癌的临床疗效[J].中华胃肠外科杂志,2017,20(1):105-106.
[2]肖毅.腹腔镜右半结肠癌CME手术技巧[J/CD].中华普外科手术学杂志(电子版),2017,11(2):99-101.
[3]Lazovic R,Radojevic N,Curovic I.Performance of primary repair on colon injuries sustained by low versus high-energy projectiles[J].Journal of Forensic and Legal Medicine,2016,39:125-129.
[4]Ren W,Shen S,Sun Z,et al.Jak-STAT3 pathway triggers DICER1for proteasomal degradation by ubiquitin ligase complex of CUL4A DCAF1 to promote colon cancer development[J].Cancer Letters,2016,375(2):209-220.
[5]史建中,钱山青,孙卫东,等.中间入路法腹腔镜右半结肠癌根治术55例临床体会[J].腹腔镜外科杂志,2016,21(10):742-744.
[6]刘广宝.手助腹腔镜下右半结肠癌根治术不同手术入路的临床疗效对比[J].中国现代普外科杂志,2014,17(6):462-464.
[7]池畔,官国先.不断提高腹腔镜右半结肠癌根治术规范化水平[J/CD].中华普外科手术学杂志(电子版),2017,11(2):91-94.
[8]王宪中,赵迎威,闫锋.大肠癌致肠梗阻的外科处理方法[J].临床研究,2016,24(7):79-79.
[9]李炳,陈卫兵,王寿青,等.腹腔镜诊治复杂型肠旋转不良七例[J].中华小儿外科杂志,2015,36(11):829-832.
[10]孙跃明.腹腔镜右半结肠癌根治术难点与关键技术[J/CD].中华普外科手术学杂志(电子版),2017,11(2):102-104.
[11]阮振兴,孙敏,李双喜.腹腔镜下不切断空肠的胆肠吻合术(Uncut Roux-en-Y)的临床应用[J].中国微创外科杂志,2016,16(6):514-517.
[12]冯士春,唐翀,袁荣华,等.腹腔镜右半结肠完整系膜切除术手术路径的探讨[J].中华普通外科杂志,2016,31(3):247-248.
[13]廖亮,王薇,许乐,等.孤立性右半结肠缺血性结肠炎预后分析[J].中华老年多器官疾病杂志,2015,14(5):326-328.
[14]邹嘹南,熊文俊,李洪明,等.尾侧人路腹腔镜右半结肠癌根治术疗效分析[J].中华胃肠外科杂志,2015,18(11):1124-1127.
[15]闫峰,白利平,王振发,等.腹腔镜辅助经自然腔道取出标本的结肠次全切除术治疗结肠冗长症[J].中华胃肠外科杂志,2016,19(8):952-955.
[16]Lien GS,Lin CH,Yang YL,et al.Ghrelin induces colon cancer cell proliferation through the GHS-R,Ras,PI3K,Akt,and m TOR signaling pathways[J].European Journal of Pharmacology,2016,776:124-131.
[17]秦绍岚,俞旻皓,慕逸飞,等.全结肠系膜切除术在右半结肠癌根治术中应用的疗效[J].中华胃肠外科杂志,2016,19(10):1101-1106.
[18]郝云鹤,王连臣,候本新,等.腹腔镜下不同入路行右半结肠癌根治术临床疗效观察[J].海南医学,2015,26(17):2598-2560.
[19]王晓斌.腹腔镜辅助下右半结肠癌根治术不同入路效果分析[J].当代医学,2014,20(9):8-9.
[20]黄勇波,张成雷,洪新凯,等.无腹部辅助切口腹腔镜改良经肛门结肠肛管吻合术治疗超低位直肠癌的临床疗效[J].中华胃肠外科杂志,2017,20(1):105-106.