手辅式腹腔镜在老年肥胖患者右半结肠癌根治术中的应用  

The application of hand-assisted laparoscopic right hemicolectomy for right colon carcinoma in elderly obesity patients

作　　者：朱光辉[1] 肖焕擎[1] 徐波[1] 戴丽华[1] 夏金堂[1] 

机构地区：[1]广州医学院附属广州市第一人民医院普外科,510180

出　　处：《中国综合临床》2008年第8期813-815,共3页Clinical Medicine of China

摘　　要：目的观察手辅式腹腔镜（HALS）应用于老年肥胖患者右半结肠癌根治术中的安全性及有效性。方法行HALS右半结肠癌根治术的老年肥胖患者20例（HAIS组），同期行开腹右半结肠癌根治术的老年肥胖患者25例为对照组，比较两组手术安全性、术后恢复情况、肿瘤根治结果以及应激反应等指标。结果两组均无手术死亡病例，均行一期吻合，HALS组无一例中转开腹，手术时间与开腹手术组差异无统计学意义（P〉0，05）；HALS组术中出血量少、术后体温恢复快、排气时间早、下床活动早、术后住院时间短，与开腹组相比差异有统计学意义（均P〈0，01）；HALS组手术切除标本长度、清扫淋巴结总数及术后并发症与开腹手术组差异无统计学意义（均P〉0，05）；C-反应蛋白、白细胞介素-6、促肾上腺皮质激素及皮质醇浓度两组手术后均明显升高，但开腹手术组升高更明显（均P〈0.05）。结论运用HALS技术能集开放和腹腔镜手术的优势完成复杂的手术，HALS右半结肠癌根治术对肥胖患者是一种安全、有效的手术方式，对术后恢复和机体应激反应有明显的改善。Objective To investigate the efficacy of hand-assisted laparoscopic right hemicolectomy for right colon carcinoma in elderly obesity patients. Methods 20 obesity cases undergoing hand-assisted laparoscopic right hemicolectomy were retrospectively reviewed,and compared with 25 obesity cases with transabdominal right hemicolectomy in the same period. The safety,recovery, eradication and stress reaction were compared. Results In hand-assisted laparoscopic group, there were less bleeding loss, rapid recovery to normal temperature and gastrointestinal function, out of bed activlty, short-time hospitalization compared with transabdominal group （ P 〈 0.01 ）. There were no differences in operative time, numbers of lymph nodes removed, postoperative complications and length of specimen between two groups （ P 〉 0.05）. CRP, IL-6 ,adrenocorticotrophic hormone （ ACTH） and cortisol were more significantly increased in two groups after operation than before operation （ P 〈 0.05 ） , and this increase was more prominent in transabdominal group than in hand-assisted laparoscopic group （ P 〈 0.05 ）. Conclusion Hand-assisted laparoscopic right hemicolectomy is a safe and effective way for elderly obesity patients, especially in postoperative recovery and physical stress reaction.

关 键 词：结肠癌 肥胖 腹腔镜 

分 类 号：R735.35[医药卫生—肿瘤]