头尾侧联合入路与中间入路腹腔镜右半结肠癌根治术的临床效果比较分析  

Comparison of the combined cranial-caudal approach versus medial-to-lateral ap⁃proach in laparoscopic radical operation of right-sided colon cancer

作　　者：沈成龙[1] 周国强[1] 郭健[1] 石志良[1] 武冠廷 陈俊杰[2] 顾闻[2] 何宋兵[2] Shen Chenglong;Zhou Guoqiang;Guo Jian;Shi Zhiliang;Wu Guanting;Chen Junjie;Gu Wen;He Songbing(Department of Gastrointestinal Surgery,Changshu No.2 People’s Hospital,Suzhou 215500,Jiangsu,China;Department of General Surgery,The First Affiliated Hospital of Soochow University,Suzhou 215006,Jiangsu,China)

机构地区：[1]常熟市第二人民医院胃肠外科,江苏苏州215500 [2]苏州大学附属第一医院普外科,江苏苏州215006

出　　处：《结直肠肛门外科》2020年第3期328-331,共4页Journal of Colorectal & Anal Surgery

基　　金：江苏省自然科学基金(BK20191172);江苏省“科教强卫工程”青年医学人才项目(QNRC2016735);苏州市科技发展计划民生科技项目(SYS2019007);常熟市科技发展计划项目(CS201910);江苏省研究生科研创新项目(KYCX19_1993)。

摘　　要：目的比较分析头尾侧联合入路与中间入路腹腔镜右半结肠癌根治术的临床效果。方法回顾性分析常熟市第二人民医院胃肠外科2015年6月至2019年11月收治的50例行腹腔镜右半结肠癌根治术患者临床资料。其中采用头尾侧联合入路23例(观察组)、中间入路27例(对照组),分析比较两组患者的临床资料。结果观察组23例患者行头尾侧联合入路腹腔镜右半结肠癌根治术,未出现肠系膜上静脉(SMV)及Henle’s干损伤及出血者;对照组27例患者行中间入路腹腔镜右半结肠癌根治术,出现SMV及Henle’s干出血共6例。两组血管损伤率比较差异有统计学意义(P<0.05)。观察组术中出血量较对照组少,手术时间较对照组短,两者差异均有统计学意义(均P<0.05)。两组淋巴结清扫数目、术后排气时间、术后平均住院时间以及肠梗阻发生情况对比,差异均无统计学意义(均P>0.05)。两组均未发生肠损伤、吻合口漏、切口感染、腹腔脓肿、输尿管损伤等并发症。结论与中间入路相比,头尾侧联合入路腹腔镜右半结肠癌根治术术中不易损伤血管、手术时间短、术中失血量少,而在术后并发症方面两者效果无明显差别,值得临床应用推广。Objectives To investigate the effectiveness of the combined cranial-caudal approach versus medial-to-lateral ap⁃proach in laparoscopic radical operation of right-sided colon cancer.Methods We retrospectively analyzed clinical data of 50 patients undergoing laparoscopic radical operation of right-sided colon cancer at the Changshu No.2 People’s Hospital between June 2015 and November 2019.Twenty-three patients underwent the combined cranial-caudal approach,and 27 underwent medi⁃al-to-lateral approach.Clinical data were compared between the two groups.Results Patients undergoing the combined cranialcaudal approach had no damage or hemorrhage of the superior mesenteric vein and Henle’s Gastrocolic Trunk.In contrast,six patients undergoing medial-to-lateral approach experienced such damages or hemorrhage.Vascular damage was significantly more common for the medial-to-lateral approach(P<0.05).The combined cranial-caudal approach had significantly less intraoperative bleeding and shorter operative time(P<0.05).There were no significant differences between the two groups in the number of har⁃vested lymph nodes,time to postoperative flatulence,postoperative hospitalization,and incidence of intestinal obstruction(P>0.05).There was no intestinal damage,anastomotic leak,wound infection,abdominal abscess,and ureteral injury in both group.Conclusion Compared with the medial-to-lateral approach,the combined cranial-caudal approach in laparoscopic radical operation of right-sided colon cancer has less vascular injury,shorter operative time,fewer intraoperative blood loss,and similar postoperative complications.It has the potential for broader clinical use.

关 键 词：右半结肠癌 腹腔镜手术 头尾侧联合入路 

分 类 号：R735.35[医药卫生—肿瘤]