网膜囊入路对比中间入路腹腔镜左半结肠癌根治术的临床疗效:倾向性评分匹配分析  

Comparison of clinical efficacy between bursa omentalis approach and medial-to-lateral approach in laparoscopic left hemicolectomy:a propensity score matching analysis

作　　者：罗思静 王玉颖 范占胜 罗立杰[4] 郑燕生[4] 李金 王伟[4] 熊文俊[4] Luo Sijing;Wang Yuying;Fan Zhansheng;Luo Lijie;Zheng Yansheng;Li Jin;Wang Wei;Xiong Wenjun(First Surgical Department,Guangdong Provincial Hospital of Chinese Medicine,Zhuhai 519015,China;Endoscopic Center,Shenzhen Traditional Chinese Medicine Anorectal Hospital,Shenzhen 518000,China;the First Department of Surgery,Zhaotong Hospital of Traditional Chinese Medicine,Yunnan Shaotong 657000,China;Department of Gastrointestinal Surgery,Guangdong Provincial Hospital of Chinese Medicine,Guangzhou 510120,China)

机构地区：[1]广东省中医院珠海医院外一科,珠海519015 [2]深圳市中医肛肠医院内镜中心,518000 [3]云南省昭通市中医医院外一科,657000 [4]广东省中医院胃肠外科,广州510120

出　　处：《中华胃肠外科杂志》2021年第10期897-903,共7页Chinese Journal of Gastrointestinal Surgery

基　　金：广州中医药大学"双一流"与高水平大学学科协同创新团队立项课题(2021xk48);广东省中医院院内专项(YN10101911)。

摘　　要：目的结肠脾曲游离技术是左半结肠癌根治术的技术难点,本研究旨在比较腹腔镜下左半结肠癌根治术网膜囊入路和中间入路的安全性和有效性。方法本研究采用回顾性队列研究方法。纳入标准:(1)施行左半结肠癌根治术;(2)术后病理结果为腺癌;(3)年龄为18~80岁;(4)无肝脏、腹膜或远处转移。排除标准:(1)身体状况较差,具有严重心、脑、肺、肝、肾和造血系统疾病者;(2)基础情况差不能耐受腹腔镜手术;(3)同时有其他恶性肿瘤病史,或多源性肿瘤;(4)因出血、梗阻和穿孔等需行急诊手术者。收集广东省中医院胃肠外科2014-2020年期间完成的189例腹腔镜左半结肠癌根治术患者临床资料。根据手术入路的不同分为网膜囊入路组(52例)和中间入路组(137例)。采用倾向性评分匹配法(PSM)对全组患者按最近邻匹配法进行1∶1匹配,卡钳值为0.01,匹配变量包括性别、年龄、美国麻醉师协会(ASA)评分、体质指数、肿瘤部位和肿瘤分期。通过PSM,网膜囊入路组与中间入路组各47例患者。两组患者基线资料的比较,差异均无统计学意义(均P>0.05),具有可比性。采用配对t检验、配对秩和检验和配对χ2检验比较两组术中及术后指标,并采用Kaplan-Meier法绘制生存曲线,组间比较采用Log-rank检验。当两条生存曲线出现交叉时,补充two-stage法和Restricted mean survival time(RMST)的组间比较结果。结果两组患者均成功完成手术,无中转开腹,无术中死亡。两组术中无联合脾脏、胰腺等脏器切除。两组患者手术时间、术中出血量、淋巴结清扫数目、术后流质饮食、术后住院时间及并发症发生情况比较,差异均无统计学意义(均P>0.05)。但网膜囊入路组的中位腹腔镜游离时间较中间入路组短,差异有统计学意义(中位数:56 min比65 min,P=0.032)。中间入路组患者中有6.4%(3/47)(体质指数均>25 kg/m^(2))术中进入错误层面,网膜�Objective Splenic flexure mobilization is technically difficult during the resection of left hemicolon cancer.This study aims to compare the safety and effectiveness between the bursa omentalis approach(BOA)and medial-to-lateral approach(MTLA)in laparoscopic radical resection of left-sided colon cancer.Methods A retrospective cohort study was conducted.Inclusion criteria:(1)patients underwent radical resection of left hemicolon cancer;(2)the postoperative pathological result was adenocarcinoma;(3)patients aged 18-80 years old;(4)no liver,peritoneal or other distant metastasis.Exclusion criteria:(1)poor physical condition with serious heart,brain,lung,liver,kidney and hematopoietic system diseases;(2)unable to tolerate laparoscopic surgery;(3)history of other malignancies simultaneously,or multisource tumors;(4)emergency operation due to bleeding,obstruction,perforation,etc.Clinical data of 189 patients who underwent laparoscopic left hemicolectomy in the Guangdong Provincial Hospital of Chinese Medicine from 2014 to 2020 were retrospectively analyzed.According to surgical approaches,patients were divided into the BOA group(52 cases)and MTLA group(137 cases).The whole group of patients were matched by propensity score matching(PSM)according to the nearest neighbor matching method.The caliper value was 0.01.The matching variables included gender,age,American Society of Anesthesiologists(ASA)score,body mass index,tumor location and tumor stage.After PSM,47 patients were included in the BOA group and MTLA group,respectively.There were no significant differences in baseline data between the two groups after PSM(all P>0.05).Paired t-test,paired rank sum test and paired Chi-square test were used to compare intraoperative and postoperative paramether between the two groups.Kaplan-Meier method was used to draw the survival curve,and log rank test was used for inter group comparison.When the two survival curves intersect,the two-stage method and restricted mean survival time(RMST)were further performed.Results Both groups

关 键 词：结肠肿瘤 左半 手术入路 网膜囊入路 中间入路 

分 类 号：R735.35[医药卫生—肿瘤]