完整结肠系膜切除术在腹腔镜右半结肠癌根治术中的应用
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摘要
目的观察完整结肠系膜切除术在腹腔镜右半结肠癌根治术中的应用效果。方法选取我院2016年1月～2018年1月收治的结肠癌患者70例,分为两组,其中对照组32例行腹腔镜传统结肠癌根治术,腹腔镜组38例行完整结肠系膜切除术,应用统计学方法,对两组术后的各项手术观察指标及并发症情况进行比较分析。结果与对照组比较,腹腔镜组的术中出血量显著减少,肛门排气时间快、住院时间短,两组组间比较,差异存在显著性(P<0.05),但两组手术时间组间比较,未见明显差异。与对照组比较,腹腔镜组术中清扫淋巴结数量明显多于对照组,且阳性淋巴结数量也明显多于对照组,两组组间比较,差异存在显著性(P<0.05)。腹腔镜组术后无一例发生吻合口瘘,其并发症发生率为5.26%,显著少于对照组,两组术后并发症组间比较,差异存在显著性(P<0.05)。结论在腹腔镜右半结肠癌根治术中采取完整结肠系膜切除术有利于减少术中出血量、促进术后恢复、减少住院时间,且术后并发症少,值得广泛推广和应用。
Objective To observe the application effect of complete mesocolic excision in the laparoscopic radical surgery of right colon cancer. Methods 70 patients with colon cancer who were admitted to our hospital from January2016 to January 2018 were selected and divided into two groups. Among them, 32 patients in the control group were given conventional laparoscopic radical surgery of radical colon. 38 patients were given complete mesocolic excision in the laparoscopy group. Statistical methods were used to compare and analyze the surgical observation indexes and complications of the two groups. Results Compared with the control group, the amount of intraoperative blood loss in the laparoscopy group was significantly reduced. The anal exhaust time was faster and the length of hospital stay was shorter.There were significant differences between the two groups(P<0.05). However, there was no significant difference between the two groups in the operation time. Compared with the control group, the number of dissected lymph nodes in the laparoscopy group was significantly higher than that in the control group. The number of positive lymph nodes was also significantly higher than that in the control group. There was significant difference between the two groups(P<0.05). No case of anastomotic leakage was detected in the laparoscopy group after surgery. The incidence rate of complications was 5.26%, which was significantly less than that in the control group. There were significant differences in postoperative complications between the two groups(P<0.05). Conclusion Complete mesocolic excision during laparoscopic radical surgery for right colon cancer is beneficial to reducing the amount of intraoperative blood loss, promoting postoperative recovery, reducing length of stay, and reducing fewer postoperative complications. It is worthy of widespread promotion and application.
Objective To observe the application effect of complete mesocolic excision in the laparoscopic radical surgery of right colon cancer. Methods 70 patients with colon cancer who were admitted to our hospital from January2016 to January 2018 were selected and divided into two groups. Among them, 32 patients in the control group were given conventional laparoscopic radical surgery of radical colon. 38 patients were given complete mesocolic excision in the laparoscopy group. Statistical methods were used to compare and analyze the surgical observation indexes and complications of the two groups. Results Compared with the control group, the amount of intraoperative blood loss in the laparoscopy group was significantly reduced. The anal exhaust time was faster and the length of hospital stay was shorter.There were significant differences between the two groups(P<0.05). However, there was no significant difference between the two groups in the operation time. Compared with the control group, the number of dissected lymph nodes in the laparoscopy group was significantly higher than that in the control group. The number of positive lymph nodes was also significantly higher than that in the control group. There was significant difference between the two groups(P<0.05). No case of anastomotic leakage was detected in the laparoscopy group after surgery. The incidence rate of complications was 5.26%, which was significantly less than that in the control group. There were significant differences in postoperative complications between the two groups(P<0.05). Conclusion Complete mesocolic excision during laparoscopic radical surgery for right colon cancer is beneficial to reducing the amount of intraoperative blood loss, promoting postoperative recovery, reducing length of stay, and reducing fewer postoperative complications. It is worthy of widespread promotion and application.
引文
[1]苏纯洁,张松柏.腹腔镜与开腹右半结肠癌完整结肠系膜切除术的临床对比研究[J].重庆医学,2014,20(26):3512-3514.
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[3]邱兴烽,叶志坚,闫峰,等.完整结肠系膜切除在腹腔镜辅助右半结肠癌根治术中的应用[J].中华普通外科杂志,2012,27(3):213-215.
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[11]殷放,翁泽滨,岑宏,等.腹腔镜右半结肠癌根治术中完整结肠系膜切除的应用[J/CD].中华腔镜外科杂志(电子版),2015,8(3):187-190.
[12]高斌,张亚铭,周潮平,等.腹腔镜辅助右半结肠癌完整结肠系膜切除术安全性及近期疗效分析[J].国际外科学杂志,2015,42(8):532-535.
[13]邢加迪,杨宏,陈蕾,等.全结肠系膜切除应用于腹腔镜辅助右半结肠癌根治术的安全性及疗效分析[J].中华胃肠外科杂志,2014,17(3):268-271.
[14]王根柱.腹腔镜全结肠系膜切除术与传统手术治疗右半结肠癌的价值对比[J].黑龙江医学,2017,41(3):235-236.
[15]王大广,所剑,张洋,等.腹腔镜下完整结肠系膜切除在右半结肠癌手术中的应用[J].中华胃肠外科杂志,2012,15(9):971-973.
[16]崔勇,姚震旦,杨宏,等.腹腔镜与开腹全结肠系膜切除术治疗右半结肠癌疗效比较[J].中华普通外科杂志,2016,31(2):155-156.
[17]叶颖江,申占龙,王杉,等.结肠癌完整结肠系膜切除术的实践与技术[J/CD].中华普外科手术学杂志(电子版),2012,6(2):4-7.
[18]王水连,卢珍友.完整全结肠系膜切除腹腔镜右半结肠癌根治术中应用的可行性研究[J].当代医学,2018,(25):167-168.
[19]Galizia G,Lieto E,DeVita F,et al.Is complete mesocolicexcision with central vascular ligation safe and effective inthe surgical treatment of right-sided colon cancers?A prospective study[J].International Journal of Colorectal Disease,2014,29(1):89-97.
[20]刘书强,赵象文,梁志宏,等.腹腔镜完整结肠系膜切除术与传统结肠癌根治术的淋巴结清扫和短期疗效比较[J].中国内镜杂志,2015,21(8):794-795.
[21]张松峰,王敬典.完整结肠系膜切除术与传统根治术治疗结肠癌的疗效[J].中国老年学杂志,2013,33(17):4280.
[22]陆学安,苗云昌.完整结肠系膜切除在结肠癌手术治疗中的应用分析[J].中外医学研究,2014,12(33):143.
[2]孔琦,王道明,胡凯峰,等.右半结肠癌行完整结肠系膜切除术和传统根治术近期疗效的分析[J].实用医学杂志,2015,16(6):959-961.
[3]邱兴烽,叶志坚,闫峰,等.完整结肠系膜切除在腹腔镜辅助右半结肠癌根治术中的应用[J].中华普通外科杂志,2012,27(3):213-215.
[4]黄进.完整结肠系膜切除术治疗右半结肠癌疗效及并发症观察[J].结直肠肛门外科,2015,21(6):446-447.
[5]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.
[6]苏向前,张成海.腹腔镜右半结肠癌CME根治术与策略[J/CD].中华普外科手术学杂志(电子版),2017,11(2):95-98.
[7]阳光,陈炜,宋向晖,等.完整结肠系膜切除术在结肠癌治疗中的应用价值分析[J].岭南现代临床外科,2015,15(1):50-52.
[8]兰晓军,姚晖,王明明,等.腹腔镜完整结肠系膜切除术治疗Ⅲ期右半结肠癌的疗效评价[J].腹腔镜外科杂志,2018,23(3):165-166.
[9]孙艳武,池畔,林惠铭,等.腹腔镜与开腹完整结肠系膜切除术的疗效比较[J].中华胃肠外科杂志,2012,15(1):24-27.
[10]池畔,陈致奋.腹腔镜右半结肠癌根治术解剖学基础与规范化手术[J].中华普外科手术学杂志(电子版),2015,9(1):7-8.
[11]殷放,翁泽滨,岑宏,等.腹腔镜右半结肠癌根治术中完整结肠系膜切除的应用[J/CD].中华腔镜外科杂志(电子版),2015,8(3):187-190.
[12]高斌,张亚铭,周潮平,等.腹腔镜辅助右半结肠癌完整结肠系膜切除术安全性及近期疗效分析[J].国际外科学杂志,2015,42(8):532-535.
[13]邢加迪,杨宏,陈蕾,等.全结肠系膜切除应用于腹腔镜辅助右半结肠癌根治术的安全性及疗效分析[J].中华胃肠外科杂志,2014,17(3):268-271.
[14]王根柱.腹腔镜全结肠系膜切除术与传统手术治疗右半结肠癌的价值对比[J].黑龙江医学,2017,41(3):235-236.
[15]王大广,所剑,张洋,等.腹腔镜下完整结肠系膜切除在右半结肠癌手术中的应用[J].中华胃肠外科杂志,2012,15(9):971-973.
[16]崔勇,姚震旦,杨宏,等.腹腔镜与开腹全结肠系膜切除术治疗右半结肠癌疗效比较[J].中华普通外科杂志,2016,31(2):155-156.
[17]叶颖江,申占龙,王杉,等.结肠癌完整结肠系膜切除术的实践与技术[J/CD].中华普外科手术学杂志(电子版),2012,6(2):4-7.
[18]王水连,卢珍友.完整全结肠系膜切除腹腔镜右半结肠癌根治术中应用的可行性研究[J].当代医学,2018,(25):167-168.
[19]Galizia G,Lieto E,DeVita F,et al.Is complete mesocolicexcision with central vascular ligation safe and effective inthe surgical treatment of right-sided colon cancers?A prospective study[J].International Journal of Colorectal Disease,2014,29(1):89-97.
[20]刘书强,赵象文,梁志宏,等.腹腔镜完整结肠系膜切除术与传统结肠癌根治术的淋巴结清扫和短期疗效比较[J].中国内镜杂志,2015,21(8):794-795.
[21]张松峰,王敬典.完整结肠系膜切除术与传统根治术治疗结肠癌的疗效[J].中国老年学杂志,2013,33(17):4280.
[22]陆学安,苗云昌.完整结肠系膜切除在结肠癌手术治疗中的应用分析[J].中外医学研究,2014,12(33):143.