尾内侧入路联合中间翻页式淋巴结清扫在腹腔镜右半结肠癌根治术中的临床应用  

Clinical application of medial caudal approach combined with middle page⁃turning lymphadenectomy in laparoscopic radical right hemicolectomy

作　　者：马松鹤 罗建飞[2] 赵晶 MA Songhe;LUO Jianfei;ZHAO Jing(Department of General Surgery,People’s Hospital of Qichun,Hubei,Qichun 435300,China;不详)

机构地区：[1]湖北省蕲春县人民医院普外科,435300 [2]武汉大学人民医院胃肠外科

出　　处：《临床外科杂志》2023年第12期1176-1179,共4页Journal of Clinical Surgery

摘　　要：目的探讨尾内侧入路联合中间翻页式淋巴结清扫在腹腔镜右半结肠癌根治术中的应用价值。方法2019年5月~2020年5月我院收治的右半结肠癌病人86例,以随机抽签法的方式将其分为观察组(43例)和对照组(43例),对照组采用中间入路法,观察组采用尾内侧入路联合中间翻页式清扫。比较两组病人的手术恢复指标、并发症发生率、血清肿瘤标志物水平、生存指标,以评估临床疗效及安全性。结果两组淋巴结清扫数量、切除肠管长度、拔管进流食及住院时间、术后并发症方面比较,差异无统计学意义(P>0.05),观察组手术时间和术中出血量明显较低,且术后排气时间较短,差异有统计学意义(P<0.05),1年后两组的血清糖类抗原19⁃9、癌胚抗原水平均有所下降,且观察组血清糖类抗原19⁃9、癌胚抗原水平低于对照组,差异有统计学意义(P<0.05);观察组的无疾病进展期延长(P<0.05),生存期比较,差异无统计学意义(P>0.05)。结论尾内侧入路联合中间翻页式淋巴结清扫在腹腔镜右半结肠癌根治术中,有利于缩短手术时间和术后排气时间,降低术中出血量和术后血清糖类抗原19⁃9、癌胚抗原水平,同时也提高了无疾病进展期,具有较高的安全性。Objective To explore the application value of medial caudal approach combined with middle page⁃turning lymphadenectomy in laparoscopic radical right hemicolectomy.Methods Eighty⁃six patients with right hemicolon cancer admitted to our hospital from May 2019 to May 2020 were selected as the research objects,and they were divided into an observation group of 43 cases and a control group of 43 cases by random drawing.The control group adopts the intermediate approach,and the observation group adopts the medial caudal approach combined with middle page⁃turning lymphadenectomy.The surgical recovery index,complication rate,serum tumor markers and survival index were compared between the two groups to evaluate the clinical efficacy and safety.Results There were no significant differences between the two groups in the number of lymph nodes removed,the length of the intestinal tube removed,extubation,fluid feeding and hospitalization time,the incidence of postoperative complications(P>0.05),but the operation time and intraoperative bleeding in the observation group were significantly lower,and the postoperative exhaust time was shorter(P<0.05).The serum CA19⁃9 and CEA levels of the two groups after one year decreased,and the serum CA19⁃9 and CEA levels of the observation group were lower than those of the control group(P<0.05).The disease⁃free progression period was prolonged in the observation group(P<0.05),but there was no difference in survival time.Conclusion The medial caudal approach combined with the middle page⁃turning lymphadenectomy has higher clinical application value in the laparoscopic radical right hemicolectomy,which is conducive to shortening the operation time and postoperative exhaust time,reducing the amount of intraoperative bleeding and postoperative serum CA19⁃9 and CEA levels,and improving the disease⁃free progression period with high safety.

关 键 词：腹腔镜 右半结肠癌根治术 尾内侧入路 中间入路 中间翻页式清扫 

分 类 号：R735.35[医药卫生—肿瘤]