“四步法”混合入路腹腔镜右半结肠癌根治性切除的初步探讨
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摘要
目的:初步探讨"四步法"混合入路腹腔镜右半结肠癌根治性切除的安全性、可行性及临床应用价值。方法:回顾分析中日友好医院普通外科2015年9月～2019年1月行腹腔镜右半结肠癌根治术患者共87例,其中采用"四步法"混合入路47例(混合入路组)、传统中间入路40例(中间入路组),分析比较2组患者的临床资料。结果:2组患者均顺利完成腹腔镜下右半结肠癌根治性切除术,性别、年龄、身高体重指数、肿瘤所在部位、分期、清扫淋巴结数目及并发症方面,差异均无统计学意义(均P>0.05)。混合入路组与中间入路组手术时间(180.6±12.0min vs 189.1±18.9min),术中出血量(74.2±19.6ml vs 106.4±64ml)比较,差异有统计学意义(均P<0.05)。结论:与中间入路相比,"四步法"混合入路腹腔镜下右半结肠癌根治术操作难度低、手术时间短、术中失血量少,值得在临床中探讨及推广应用。
Objective:To investigate the safety,feasibility and clinical value of "four-step" mixed approach by laparoscopy for radical resection of right colon cancer.Methods:A retrospective analysis was performed on 87 cases of right colon cancer with radical surgery by laparoscopy from September 2015 to January 2019 in the General Surgery Department of China-Japan Friendship Hospital.It included 47 cases using "four-step" mixed approach(MA group)and 40 cases,the traditional intermediate approach(IM group).The clinical data of the two groups were analyzed and compared.Results:Radical resection by laparoscopy on right colon cancer of patients was successfully performed in both groups.The clinical data of the two groups,such as gender,age,height and body mass index,tumor location group,lymph node dissection number or complications,were not statistically significant(P>0.05).Compared with the IM group,the MA group cost less operation time(180.6±12.0 min vs189.1±18.9 min)and reduced the intraoperative blood loss(74.2±19.6 ml vs 106.4±64 ml),these above data were statistically significant(P <0.05).Conclusion:Compared with the intermediate approach,the "four-step" mixed approach for radical operation on right colon cancer by laparoscopy is safe and feasible.It can shorten the operation time,reduce the blood loss.It is worthy of further discussion and promotion in the clinic application.
Objective:To investigate the safety,feasibility and clinical value of "four-step" mixed approach by laparoscopy for radical resection of right colon cancer.Methods:A retrospective analysis was performed on 87 cases of right colon cancer with radical surgery by laparoscopy from September 2015 to January 2019 in the General Surgery Department of China-Japan Friendship Hospital.It included 47 cases using "four-step" mixed approach(MA group)and 40 cases,the traditional intermediate approach(IM group).The clinical data of the two groups were analyzed and compared.Results:Radical resection by laparoscopy on right colon cancer of patients was successfully performed in both groups.The clinical data of the two groups,such as gender,age,height and body mass index,tumor location group,lymph node dissection number or complications,were not statistically significant(P>0.05).Compared with the IM group,the MA group cost less operation time(180.6±12.0 min vs189.1±18.9 min)and reduced the intraoperative blood loss(74.2±19.6 ml vs 106.4±64 ml),these above data were statistically significant(P <0.05).Conclusion:Compared with the intermediate approach,the "four-step" mixed approach for radical operation on right colon cancer by laparoscopy is safe and feasible.It can shorten the operation time,reduce the blood loss.It is worthy of further discussion and promotion in the clinic application.
引文
[1]郑民华.腹腔镜手术---结直肠癌根治性手术金标准?[J].中国实用外科杂志,2012,32(9):731-733.
[2]Fleshman J,Sargent DJ,Green E,et al.Laparoscopic colectomy for cancer is not inferior to open surgery based on 5-year data from the COST Study Group trial[J].Ann Surg,2007,246(4):655-662;discussion 662-664.
[3]Rondelli F,Trastulli S,Avenia N,et al.Is laparoscopic right colectomy more effective than open resection?A meta-analysis of randomized and nonrandomized studies[J].Colorectal Dis,2012,14(8):e447-469.
[4]McCombie AM,Frizelle F,Bagshaw PF,et al.The ALCCaSTrial:A randomized controlled trial comparing quality of life following laparoscopic versus open colectomy for colon cancer[J].Dis Colon Rectum,2018,61(10):1156-1162.
[5]Pecorelli N,Amodeo S,Frasson M,et al.Ten-year outcomes following laparoscopic colorectal resection:results of a randomized controlled trial[J].Int J Colorectal Dis,2016,31(7):1283-1290.
[6]郑民华,马君俊.腹腔镜右半结肠癌根治术的难点与争议[J].中华普外科手术学杂志(电子版),2018,(3):181-184.
[7]邹瞭南,李洪明,万进.腹腔镜尾侧入路右半结肠癌根治性切除的安全性、可行性及临床应用价值[J].中华结直肠疾病电子杂志,2016,5(3):238-243.
[8]Lorenzon L,Montebelli F,Mercantini P,et al.Right colectomy for cancer:A matched comparison of three different surgical approaches[J].J Invest Surg,2016,29(6):405-412.
[9]舒若,刘童蕾,田衍,等.尾侧入路与中间入路行腹腔镜下右半结肠癌根治术临床对比[J].昆明医科大学学报,2018,(5):78-82.
[10]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,(17):2598-2600.
[11]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,(10):742-745.
[12]陈庆永,帅晓明,陈立波.中间尾侧联合入路行腹腔镜D3淋巴结清扫加完整结肠系膜切除术治疗右半结肠癌合并不全性肠梗阻的安全性和可行性[J].中华胃肠外科杂志,2018,21(9):1039-1044.
[13]Honaker M,Scouten S,Sacksner J,et al.A medial to lateral approach offers a superior lymph node harvest for laparoscopic right colectomy[J].Int J Colorectal Dis,2016,31(3):631-634.
[14]邹瞭南,郑蓓诗,卢新泉,等.腹腔镜尾侧入路法根治性右半结肠切除术[J].中华结直肠疾病电子杂志,2017,6(2):170-173.
[15]Matsuda T,Iwasaki T,Sumi Y,et al.Laparoscopic complete mesocolic excision for right-sided colon cancer using a cranial approach:anatomical and embryological consideration[J].Int J Colorectal Dis,2017,32(1):139-141.
[2]Fleshman J,Sargent DJ,Green E,et al.Laparoscopic colectomy for cancer is not inferior to open surgery based on 5-year data from the COST Study Group trial[J].Ann Surg,2007,246(4):655-662;discussion 662-664.
[3]Rondelli F,Trastulli S,Avenia N,et al.Is laparoscopic right colectomy more effective than open resection?A meta-analysis of randomized and nonrandomized studies[J].Colorectal Dis,2012,14(8):e447-469.
[4]McCombie AM,Frizelle F,Bagshaw PF,et al.The ALCCaSTrial:A randomized controlled trial comparing quality of life following laparoscopic versus open colectomy for colon cancer[J].Dis Colon Rectum,2018,61(10):1156-1162.
[5]Pecorelli N,Amodeo S,Frasson M,et al.Ten-year outcomes following laparoscopic colorectal resection:results of a randomized controlled trial[J].Int J Colorectal Dis,2016,31(7):1283-1290.
[6]郑民华,马君俊.腹腔镜右半结肠癌根治术的难点与争议[J].中华普外科手术学杂志(电子版),2018,(3):181-184.
[7]邹瞭南,李洪明,万进.腹腔镜尾侧入路右半结肠癌根治性切除的安全性、可行性及临床应用价值[J].中华结直肠疾病电子杂志,2016,5(3):238-243.
[8]Lorenzon L,Montebelli F,Mercantini P,et al.Right colectomy for cancer:A matched comparison of three different surgical approaches[J].J Invest Surg,2016,29(6):405-412.
[9]舒若,刘童蕾,田衍,等.尾侧入路与中间入路行腹腔镜下右半结肠癌根治术临床对比[J].昆明医科大学学报,2018,(5):78-82.
[10]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,(17):2598-2600.
[11]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,(10):742-745.
[12]陈庆永,帅晓明,陈立波.中间尾侧联合入路行腹腔镜D3淋巴结清扫加完整结肠系膜切除术治疗右半结肠癌合并不全性肠梗阻的安全性和可行性[J].中华胃肠外科杂志,2018,21(9):1039-1044.
[13]Honaker M,Scouten S,Sacksner J,et al.A medial to lateral approach offers a superior lymph node harvest for laparoscopic right colectomy[J].Int J Colorectal Dis,2016,31(3):631-634.
[14]邹瞭南,郑蓓诗,卢新泉,等.腹腔镜尾侧入路法根治性右半结肠切除术[J].中华结直肠疾病电子杂志,2017,6(2):170-173.
[15]Matsuda T,Iwasaki T,Sumi Y,et al.Laparoscopic complete mesocolic excision for right-sided colon cancer using a cranial approach:anatomical and embryological consideration[J].Int J Colorectal Dis,2017,32(1):139-141.