中间尾侧联合入路腹腔镜下右半结肠切除术治疗右半结肠癌合并不全性肠梗阻的疗效及安全性

Effect and safety of laparoscopic right hemicolectomy through midcaudal combined approach in treatment of right hemicolon cancer combined with incomplete intestinal obstruction

摘要:

目的探讨中间尾侧联合入路腹腔镜下右半结肠切除术治疗右半结肠癌合并不全性肠梗阻的疗效及安全性。方法选取2019年1月至2020年1月在新乡市中心医院接受腹腔镜下右半结肠切除术治疗的55例右半结肠癌合并不全性肠梗阻患者为研究对象,按照手术方式分为A组29例和B组26例。A组患者接受中间尾侧联合入路腹腔镜手术,B组患者接受中间入路腹腔镜手术,比较两组患者的围术期指标、术后应激反应、近期疗效及安全性。结果 A组患者的手术时间短于B组,失血量少于B组(P<0.05),但两组间的排气恢复时间、引流管留置时间比较,差异无统计学意义(P>0.05);A组患者白介素-6 (IL-6)、C-反应蛋白(CRP)、肿瘤坏死因子-α(TNF-α)水平低于B组(P<0.05);两组间的中转开腹率、并发症发生率、一年生存率比较,差异无统计学意义(P>0.05)。结论右半结肠癌合并不全肠梗阻患者采用中间尾侧联合入路腹腔镜手术安全有效,操作难度低,手术风险小,可以明显缩短手术时间、减少术中出血量、降低患者术后应激反应。

Abstract:

【Objective】 To explore the effect and safety of laparoscopic right hemicolectomy through midcaudal combined approach in the treatment of right hemicolon cancer combined with incomplete intestinal obstruction. 【Methods】 A total of 55 patients with right hemicolon cancer and incomplete intestinal obstruction undergoing laparoscopic right hemicolectomy in the hospital were enrolled as the research objects between January 2019 and January 2020. According to different approaches, they were divided into group A(29 cases, midcaudal combined approach) and group B(26 cases, medial approach). The perioperative indexes,postoperative stress response, short-term curative effect and safety between the two groups were compared. 【Results】 The operation time in group A was shorter than that in group B, and blood loss was less than that in group B(P<0.05). There was no significant difference in exhaust recovery time or indwelling time of drainage tube between the two groups(P>0.05). The levels of interleukin-6(IL-6), C-reactive protein(CRP) and tumor necrosis factor-α(TNF-α) in group A were lower than those in group B(P<0.05).There was no significant difference in rate of conversion to laparotomy, incidence of complications and 1-year survival rate between the two groups(P>0.05). 【Conclusion】 The laparoscopic right hemicolectomy through midcaudal combined approach is safe and effective in the treatment of patients with right hemicolon cancer and incomplete intestinal obstruction, with low operation difficulty and surgical risk. It can significantly shorten operation time, reduce intraoperative blood loss and reduce postoperative stress response.