三孔法腹腔镜右半结肠癌根治术的临床效果  

The clinical effect of laparoscopic right hemicolectomy by using three-hole method

作　　者：何平[1] 梁杰雄[1] 邵天松[1] 宋辉[1] 张钊[1] 郭洋[1] 李洋[1] 

机构地区：[1]首都医科大学附属北京安贞医院普外科,100029

出　　处：《中华普外科手术学杂志（电子版）》2017年第5期400-402,共3页Chinese Journal of Operative Procedures of General Surgery(Electronic Edition)

基　　金：首都医科大学基础-临床科研合作基金项目(14JL65)~~

摘　　要：目的探索三孔法微创手术方案在右半结肠癌患者中的应用效果。方法回顾性分析2009年11月至2014年12月进行腹腔镜右半结肠癌手术的95例患者资料,分为五孔组(47例)和三孔组(48例)。五孔组患者进行常规"五孔法"手术,三孔组患者采用"三孔法"手术治疗。应用统计学软件SPSS 19.0进行数据分析,术中术后各项指标比较用均数±标准差,采用t检验;术后并发症发生率和生存率比较采用χ2检验,P<0.05差异具有统计学意义。结果术中出血量及淋巴结清扫数目两组相比差异无统计学意义;三孔组手术时间、术后通气时间、进食时间、引流时间均低于五孔组;两组患者术后WBC、CRP及IL-6水平均明显高于手术前(P<0.01),但五孔组的术后水平更高于三孔组,差异具有统计学意义(P<0.05);三孔组术后12个月生存率(97.9%)高于五孔组(93.6%)(χ2=2.16,P<0.05);三孔组术后18个月生存率(93.8%)高于五孔组(89.4%)(χ2=3.67,P<0.05);三孔组术后24个月生存率(91.7%)高于五孔组(82.9%)(χ2=4.01,P<0.05),以上差异具有统计学意义;三孔组复发、转移及并发症总例数共7例(14.58%)低于五孔组14例(19.79%)。结论 "三孔法"微创手术方案优于常规腹腔镜五孔法,其生存率高、复发及转移率低、并发症少,值得在临床推广使用。Objecti To explore the clinical effect of laparoscopic right hemicolectomy by using three-hole method. Methods From November 2009 to December 2014, a retrospective analysis of laparoscopic right hemicolectomy of 95 patients were performed, including 47 cases in five holes group and 48 cases in three holes group.Clinical data were analyzed by using statistical software SPSS 19.0.Measurement data such as perioperative indicators were expressed as mean ±standard deviation（-x ±s）, and were examined by using t test.Count data, such as postoperative complication rate and survival rate , were expressed as %, and were examined by using χ2 test.A P value 〈0.05 was considered as statistically significant difference. Results There were no significantly differenence between χ2 groups in terms of intraoperative blood loss and harvested lymph nodes.Compared with five holes group, operation time, exhaust time, feeding time and drainage time in three holes group were significantly decreased .There were postoperative increase of blood WBC、 CRP and IL-6 in both two groups （P 〈0.05）, however five-hole group were significantly higher than that of the three-hole group （P 〈0.01）.The 12-month survival rate （97.9%） of three holes group was higher than 93.6% of five holes group （χ2 =2.16, P 〈0.05）.The 18-month survival rate （93.8%） of three holes group was higher than 89.4% of five holes group （χ2 =3.67, P 〈0.05）.The 18-month survival rate （91.7%） of three holes group was higher than 82.9% of five holes group （χ2 =4.01, P 〈0.05）.The total number of recurrence, metastasis and complication in the three -hole group was 75 （14.58%） lower than 14 （19.79%） in the five-hole group. Conclusion Minimally invasive surgical procedure by using three -hole method is superior to conventional five -hole method, with higher survival rate, lower recurrence and complication rate.it is worth clinical wider application .

关 键 词：结肠肿瘤 外科手术 微创性 治疗结果 复发 

分 类 号：R735.35[医药卫生—肿瘤]