腹腔镜右半结肠切除尾侧入路与头侧入路的前瞻性随机对照研究
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摘要
目的比较尾侧入路与头侧入路在右半结肠癌行腹腔镜右半结肠切除术的近期疗效。方法于2017年1月—2018年7月,将入院拟行手术治疗的38例右半结肠癌患者按随机数字表前瞻性随机分为两组(各19例),分别行尾侧入路和头侧入路腹腔镜右半结肠切除术,比较两组手术时间、术中出血量、淋巴结清扫情况、术中及术后并发症。结果尾侧入路与头侧入路两组患者手术时间分别为(121. 4±25. 2)及(152. 1±31. 7) min,术中出血量分别为(52. 4±25. 2)及(82. 4±30. 8) mL,差异均有统计学意义,淋巴结清扫数目分别为(17. 8±4. 1)和(17. 3±3. 8)枚,术中并发症各有1例,术后并发症有2例及1例,差异均无统计学意义。结论尾侧入路较头侧入路在腹腔镜右半结肠切除术中可明显缩短手术时间,减少术中出血量,简便、安全和易掌握,值得临床推广。
Objective To compare the caudal-to-cranial approach with cranial-to-caudal approach in laparoscopic right hemi-colectomy for right colon cancer. Methods A prospective randomized controlled trial was performed in Ganzhou people's Hospital between January 2017 to July 2018. Thirty-eight cases with right colon cancer were randomly divided into two groups: caudal-to-cranial laparoscopic right hemi-colectomy and cranial-to-caudal laparoscopic right hemi-colectomy. These two groups were compared in view of operation time,intraoperative blood loss,lymph node dissection,intraoperative and postoperative complications. Results Comparing caudal-to-cranial approach with cranial-to-caudal approach,we got statistics: operation time in both groups were respectively(121. 4 ± 25. 2) min and(152. 1 ± 31. 7)min; intraoperative blood loss,respectively(52. 4 ± 25. 2) mL and(82. 4 ± 30. 8) mL. There were statistically significant differences. The number of lymph node dissection was(17. 8 ± 4. 1) vs.(17. 3 ± 3. 8),respectively. 1 case ended up with intraoperative complications and 2 cases with postoperative complications in caudal-to-cranial approach. 1 case developed with intraoperative complications and 1 with postoperative complications for the group with the cranial-to-caudal approach,the differences not statistically significant. Conclusion Compared with cranial-to-caudal approach,caudal-to-cranial approach can significantly shorten operation time,and reduce intraoperative blood loss. It is simple,safe and easy for application,so it is worthy of clinical promotion.
Objective To compare the caudal-to-cranial approach with cranial-to-caudal approach in laparoscopic right hemi-colectomy for right colon cancer. Methods A prospective randomized controlled trial was performed in Ganzhou people's Hospital between January 2017 to July 2018. Thirty-eight cases with right colon cancer were randomly divided into two groups: caudal-to-cranial laparoscopic right hemi-colectomy and cranial-to-caudal laparoscopic right hemi-colectomy. These two groups were compared in view of operation time,intraoperative blood loss,lymph node dissection,intraoperative and postoperative complications. Results Comparing caudal-to-cranial approach with cranial-to-caudal approach,we got statistics: operation time in both groups were respectively(121. 4 ± 25. 2) min and(152. 1 ± 31. 7)min; intraoperative blood loss,respectively(52. 4 ± 25. 2) mL and(82. 4 ± 30. 8) mL. There were statistically significant differences. The number of lymph node dissection was(17. 8 ± 4. 1) vs.(17. 3 ± 3. 8),respectively. 1 case ended up with intraoperative complications and 2 cases with postoperative complications in caudal-to-cranial approach. 1 case developed with intraoperative complications and 1 with postoperative complications for the group with the cranial-to-caudal approach,the differences not statistically significant. Conclusion Compared with cranial-to-caudal approach,caudal-to-cranial approach can significantly shorten operation time,and reduce intraoperative blood loss. It is simple,safe and easy for application,so it is worthy of clinical promotion.
引文
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[7]杨世斌,韩方海,肖隆斌,等.腹腔镜辅助右半结肠癌根治术与开放手术的临床应用比较[J].实用医学杂志,2016,32(11):1819-1822.
[8]丁海涛,吴涛,张策,等.腹腔镜下腹膜后筋膜间隙外科平面的解剖观察[J].解剖学报,2009,40(2):328-331.
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[10]ZOU L N,XIONG W J,MO,D L,et al.Laparoscopic Radical Extended Right Hemicolectomy Using a Caudal-to-Cranial Appraoch[J].Ann Surg Oncol,2016,23(8):2562-2563.
[11]COFEY J C,CULLIGAN K,WALSH L G,et,al.An appraisal of the computed axial tomographic appearance of the human mesentery based on mesenteric contiguity from the duodenojejunal flexure to the mesorectal level[J].Eur Radiol,2016,26(3):714-721.
[2]严俊,应敏刚,周东,等.腹腔镜右半结肠切除中间入路与侧方入路的前瞻性随机对照临床研究[J].中华胃肠外科杂志,2010,13(6):403-405.
[3]池畔.腹腔镜右半结肠癌根治术手术入路的选择[J].中华胃肠外科杂志,2016,19(8):875-877.
[4]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.
[5]郑波波,王楠,吴涛,等.改良中间入路与传统中间入路在腹腔镜右半结肠切除术中的比较研究[J].中华胃肠外科杂志,2015,18(8):812-816.
[6]周亮.腹腔镜右半结肠切除术治疗结肠癌的近远期疗效观察[J].国际医药卫生导报,2016,22(6):796-798.
[7]杨世斌,韩方海,肖隆斌,等.腹腔镜辅助右半结肠癌根治术与开放手术的临床应用比较[J].实用医学杂志,2016,32(11):1819-1822.
[8]丁海涛,吴涛,张策,等.腹腔镜下腹膜后筋膜间隙外科平面的解剖观察[J].解剖学报,2009,40(2):328-331.
[9]YAMAGUCHI S,KUROYANAGI H,MILSOM J W,et al.Venous anatomy of the right colon:precise structure of the major and gastrocolic trunk in 58 cadavers[J].Dis Colon Rectum,2002,45:1337-1340.
[10]ZOU L N,XIONG W J,MO,D L,et al.Laparoscopic Radical Extended Right Hemicolectomy Using a Caudal-to-Cranial Appraoch[J].Ann Surg Oncol,2016,23(8):2562-2563.
[11]COFEY J C,CULLIGAN K,WALSH L G,et,al.An appraisal of the computed axial tomographic appearance of the human mesentery based on mesenteric contiguity from the duodenojejunal flexure to the mesorectal level[J].Eur Radiol,2016,26(3):714-721.