腹腔镜辅助在根治性右半结肠切除术中的临床应用  

Application of laparoscopy in radical right hemicolectomy

作　　者：江树嵩[1] 廖康雄[1] 魏文波[1] JIANG Shu-song;LIAO Kang-xiong;WEI Wen-bo(First Department of General Surgery, Jieyang People's Hospital, Jieyang 522000, Guangdong, CHINA)

机构地区：[1]揭阳市人民医院普通外科一区

出　　处：《海南医学》2019年第13期1691-1693,共3页Hainan Medical Journal

摘　　要：目的探讨腹腔镜辅助根治性右半结肠切除术的临床应用效果。方法回顾性分析揭阳市人民医院普通外科一区2013年8月至2017年8月收治的95例右半结肠癌根治术患者的临床资料,根据手术方式不同将患者分为腹腔镜组47例和开腹组48例。腹腔镜组采用腹腔镜辅助根治性右半结肠切除术,开腹组采用常规开腹手术,比较两组患者的手术情况(手术时间、切口长度、术中出血量)、术中淋巴结清扫情况(肠系膜根部淋巴结清扫数、阳性淋巴结检出率)、术后肠道功能恢复情况(术后肛门首次排气排便时间、腹胀腹痛持续时间、住院时间),以及术后并发症的发生和肿瘤复发转移情况。结果腹腔镜组与开腹组患者的手术时间[(156.51±16.62) min vs (126.62±15.51) min]、术中出血量[(85.52±15.73) mL vs (100.85±18.95) mL]和切口长度[(5.23±0.65) cm vs (18.52±3.68) cm]比较,腹腔镜组手术时间长于开腹组,术中出血量少于对照组,切口长度小于对照组,差异均有统计学意义(P<0.05);腹腔镜组与开腹组患者的淋巴结清扫数目[(5.01±1.60)个 vs (5.22±1.57)个]和阳性淋巴结比例(8.51% vs 10.42%)比较,差异均无统计学意义(P>0.05);腹腔镜组与开腹组患者的首次排气时间[(2.21±1.28) d vs (3.82±1.51) d]、首次排便时间[(2.51±1.76) d vs (4.58±1.82) d]、腹痛腹胀持续时间[(2.01±0.82) d vs (3.59±1.57) d]、住院时间[(7.15±2.08) d vs(15.35±3.65) d]比较,腹腔镜组均明显短于开腹组,差异均有统计学意义(P<0.05);腹腔镜组与开腹组患者术后肿瘤复发率分别为2.13%和 2.08%、转移率分别为4.26%和6.25%,差异均无统计学意义(P>0.05)。结论腹腔镜辅助根治性右半结肠切除术具有和开腹手术同样的临床疗效,且微创、利于术后恢复。Objective To investigate the application value of laparoscopy in radical right hemicolectomy.Methods The clinical data 95 patients with right colon cancer who underwent radical operation in Department of Gen-eral Surgery of Jieyang People's Hospital from August 2013 to August 2017 was respectively analyzed. The patientswere divided into the laparoscopic group (47 cases) and the laparotomy group (48 cases) according to different surgerymethods. Laparoscopic-assisted radical right hemicolectomy was performed in the laparoscopic group and conventionallaparotomy was performed in the laparotomy group. The operation conditions (operation time, incision length, intraoper-ative bleeding volume), lymph node dissection (number of lymph node dissection at mesenteric root, positive lymphnode detection rate), recovery of intestinal function (time of first exhaust and defecation after operation, duration of ab-dominal distention and abdominal pain, hospital stay), complications and recurrence and metastasis of tumors were com-pared between the two groups. Results The operation time was (156.51±16.62) min of the laparoscopic group versus(126.62±15.51) min of the laparotomy group;the intraoperative bleeding volume was (85.52±15.73) mL versus (100.85±18.95) mL, and the incision lengths was (5.23±0.65) cm versus (18.52±3.68) cm (all P<0.05). The number of lymphnode dissection was 5.01±1.60 in the laparoscopic group versus 5.22±1.57 in the laparotomy group;the proportion ofpositive lymph nodes was 8.51% versus 10.42%(all P>0.05). The first exhaust time was (2.21±1.28) d of the laparoscop-ic group versus (3.82±1.51) d of the laparotomy group;the first defecation time was (2.51±1.76) d versus (4.58±1.82) d;the duration of abdominal pain and distention was (2.01±0.82) d versus (3.59±1.57) d;the length of stay was (7.15±2.08) dversus (15.35±3.65) d (all P<0.05). The recurrence rate was 2.13% in laparoscopic groupversus 2.08% in laparotomygroup;the metastasis rate was 4.26% versus 6.25%(all P>0.05). Conclusion Laparoscop

关 键 词：腹腔镜 根治性右半结肠切除术 结肠肿瘤 结肠 微创 

分 类 号：R656.9[医药卫生—外科学]