摘要
目的:通过与腹腔镜辅助右半结肠切除术对比,评价全腹腔镜右半结肠切除术治疗右半结肠癌的临床疗效。方法:采用前瞻性对照研究,将2014年01月至2018年12月我院普外科收治的右半结肠癌患者,根据吻合方式不同,按照纳入与排除标准分为体外吻合组(extracorporeal anastomosis,EA)和体内吻合组(intracorporeal anastomosis,IA),比较不同吻合方式下两组患者的肿瘤根治性、手术时间、术后恢复情况和术后并发症的变化。结果:入组病例共184例,EA组98例,IA组86例。两组患者在年龄、性别、体质量指数(body mass index,BMI)、ASA评分、肿瘤部位和TNM分期方面没有显著差异。就手术中切除的淋巴结数量而言,两种手术方式的肿瘤根治性没有显著差异。两组患者的手术时间也没有统计学差异。但是IA组患者的术后排气时间明显早于EA组[(1.2±0.8)d vs(2.3±1.0)d,P<0.001],且IA组患者术后并发症发生率也低于EA组(OR=0.907,95%CI:0.855~0.961,P=0.024)。进一步将其分层比较后研究发现,两组患者术后的Ⅰ级和Ⅱ级轻型并发症比较仍有显著差异(OR=0.632,95%CI:0.422~0.946,P=0.005);但Ⅲ-Ⅴ级重型并发症比较无显著差异。两组患者术后3年内的生存曲线显示预后无显著差异。结论:相较于体外吻合,体内吻合是全腹腔镜右半结肠切除术中更好的消化道重建方式。
Objective:By comparing with laparoscopic-assisted right hemicolectomy,the clinical efficacy of total laparoscopic right hemicolectomy for right colon cancer was evaluated.Methods:A prospective controlled study was used.Patients with right colon cancer admitted to our hospital from January 2014 to December 2018 were divided into an extracorporeal anastomosis(EA)group and an intracorporeal anastomosis(IA)group according to the inclusion and exclusion criteria.The changes in tumor radicality,operative time,postoperative recovery and postoperative complications between the two groups were compared.Results:A total of 184 cases were included in the study.98 cases and 86 cases were in the EA group and the IA group,respectively.There were no significant differences between the two groups in terms of age,gender,body mass index(BMI),ASA scores,tumor location and TNM stage.In terms of the number of lymph nodes harvested during surgery,there was no significant difference in the oncologic radicality of the two groups.And there was no statistical difference in operation time between the two groups.Time to flatus after surgery in IA group was significantly earlier than that in EA group[(1.2±0.8)d vs(2.3±1.0)d,P<0.001].The incidence of postoperative complications in IA group was also lower than that in EA group(OR=0.907,95%CI:0.855~0.961,P=0.024).However,when stratifying according to Clavien-Dindo classification,the difference was consistently confirmed between the two groups for less severe(classⅠandⅡ)complications(OR=0.632,95%CI:0.422~0.946,P=0.005),but not for classⅢ-Ⅴcomplications.The survival curves of the two groups showed no significant difference in prognosis.Conclusion:Our results are encouraging to consider the intracorporeal approach the better way to fashion the anastomosis after total laparoscopic right hemicolectomy.
作者
朱鹏程
李明
缪文忠
顾锋
蒋建龙
陆志华
ZHU Pengcheng;LI Ming;MIAO Wenzhong;GU Feng;JIANG Jianlong;LU Zhihua(Department of General Surgery,Changshu Hospital Affiliated to Soochow University,Jiangsu Changshu 215500,China;Department of Radiology,Changshu Hospital Affiliated to Soochow University,Jiangsu Changshu 215500,China)
出处
《现代肿瘤医学》
CAS
北大核心
2022年第14期2553-2557,共5页
Journal of Modern Oncology
基金
江苏省青年医学重点人才计划(编号:QNRC2016212)
江苏省苏州市临床重点病种诊疗计术专项(编号:LCZX201823)
江苏省苏州市“科教兴卫”青年科技项目(编号:KJXW2020064)。
关键词
全腹腔镜
腹腔镜辅助
吻合
右半结肠切除术
total laparoscopic
laparoscopic-assisted
anastomosis
right hemicolectomy
