腹腔镜下不同入路手术治疗右半结肠癌的临床效果_冯兴波.pdf

中国当代医药2023年1月第30卷第3期CHINA MODERN MEDICINE Vol.30 No.3 January 2023肿瘤医学作者简介冯兴波（1982-），男，山东枣庄人，硕士，研究方向：胃肠外科肿瘤。通讯作者唐文东（1969-），男，安徽亳州人，主任医师，研究方向：胃肠外科。腹腔镜下不同入路手术治疗右半结肠癌的临床效果冯兴波唐文东贾静叶朋山东省枣庄矿业集团中心医院胃肠外科，山东枣庄 277000摘要目的探讨腹腔镜下不同入路手术方法治疗右半结肠癌患者的有效性以及安全性。方法选取 2018 年 1 月至 2020 年 12 月枣庄矿业集团中心医院收治的 40 例右半结肠癌患者作为研究对象，采用随机数字表法将其分为常规组和研究组，每组各 20 例。常规组患者采用腹腔镜下中间入路手术方式完成治疗，研究组患者采用腹腔镜下回字型右下入路手术方式完成治疗。比较两组患者术中、术后相关指标（淋巴结清扫数量、术中失血量、手术时间、术后排气时间以及住院时间）；比较两组患者手术前后的癌胚抗原（CEA）、肿瘤特异性生长因子（TSGF）水平；比较两组患者术后并发症（吻合口漏、肠梗阻、切口感染、腹腔感染、尿路感染）总发生率。结果研究组患者的淋巴结清扫数量为（27.395.75）枚，多于常规组的（19.235.63）枚，术中失血量为（50.869.89）ml，少于常规组的（67.858.95）ml，手术时间为（133.2921.03）min，术后排气时间为（2.750.31）d，住院时间为（10.762.36）d，均短于常规组的（173.3519.29）min、（3.310.29）d 以及（17.312.51）d，差异有统计学意义（P0.05）。术前，研究组患者的 CEA 水平为（17.852.12）g/L，TSGF 水平为（77.863.26）U/ml，与常规组的（17.911.99）g/L、（78.033.11）U/ml 比较，差异无统计学意义（P0.05）；术后，研究组患者的 CEA 水平为（10.021.39）g/L，TSGF水平为（72.211.63）U/ml，与常规组的（10.231.43）g/L、（72.221.72）U/ml 比较，差异无统计学意义（P0.05）；两组患者术后的 CEA、TSGF 水平均低于术前，差异有统计学意义（P0.05）。研究组患者的术后并发症总发生率（5.00%）低于常规组（50.00%），差异有统计学意义（P0.05）。结论与腹腔镜下中间入路手术方式比较，腹腔镜下回字型右下入路手术方式治疗右半结肠癌患者，可显著改善患者术中、术后系列指标，并降低并发症发生率，可促进右半结肠癌患者的总体预后水平提升。关键词右半结肠癌；腹腔镜下回字型右下入路手术方式；腹腔镜下中间入路手术方式；术中术后相关指标；癌胚抗原；肿瘤特异性生长因子；术后并发症中图分类号 R735.35文献标识码 A文章编号 1674-4721（2023）1（c）-0095-04Clinical effect of different approaches under laparoscopy in the treatmentof right colon cancerFENG XingboTANG WendongJIA JingYE PengDepartment of Gastrointestinal Surgery,Central Hospital,Zaozhuang Mining Group,Shandong Province,Zaozhuang277000,ChinaAbstract Objective To investigate the efficacy and safety of different laparoscopic approaches in the treatment of patientswith right colon cancer.Methods From January 2018 to December 2020,40 patients with right colon cancer who wereadmitted to the Central Hospital,Zaozhuang Mining Group were selected as the research subjects.They were divided into aroutine group and a study group by the random number table method,with 20 cases in each group.The patients in theroutine group were treated by laparoscopic intermediate approach,the patients in the study group were treated by thelaparoscopic lower right approach in“Hui”(Chinese character)type.Intraoperative and postoperative indexes(number oflymph nodes dissection,intraoperative blood loss,operation time,postoperative exhaust time and hospital stay)werecompared between the two groups.The levels of carcino-embryonic antigen(CEA)and tumor supplied group of factors(TSGF)before and after surgery were compared between the two groups.The total incidence of postoperative complications(anastomotic leakage,intestinal obstruction,incision infection,abdominal infection and urinary tract infection)was comparedbetween the two groups.Results The number of lymph node dissection in the study group was(27.395.75),more than thatin the conventional group of(19.235.63),the intraoperative blood loss was(50.869.89)ml,less than that in theconventional group of(67.858.95)ml,the operative timewas(133.2921.03)min,postoperative exhaust time andhospitalizationtimewere(2.750.31)dand(10.762.36)d,both of which were shorter than(173.35 19.29)min,95肿瘤医学中国当代医药2023年1月第30卷第3期CHINA MODERN MEDICINE Vol.30 No.3 January 2023(3.310.29)d and(17.312.51)d in the conventional group,and the differences were statistically significant(P0.05).Before surgery,CEA level of the study group was(17.852.12)g/L,TSGF level was(77.863.26)U/ml,compared with theconventional group of(17.911.99)g/L and(78.033.11)U/ml,the differences were not statistically significant(P0.05).After surgery,CEA level in study group was(10.021.39)g/L,TSGF level was(72.211.63)U/ml,compared withthe conventional group of(10.231.43)g/L and(72.221.72)U/ml,the differences were not statistically significant(P0.05).After surgery,CEA and TSGF levels in the groups were lower than those before surgery,and the differences werestatistically significant(P0.05).The total incidence of postoperative complications in the study group(5.00%)was lowerthan that in the conventional group(50.00%),and the difference was statistically significant(P0.05).ConclusionLaparoscopic lower right approach in Hui type is effective.Compared with laparoscopic intermediate approach,it cansignificantly improve the patients intraoperative and postoperative indicators,reduce the incidence of complications,andpromote the overall prognosis of patients with right colon cancer.Key words Right colon cancer;Laparoscopic lower right approach in Hui type;Laparoscopic intermediate approach;Intraoperativeandpostoperativerelatedindicators;Carcino-embryonicantigen;Tumor supplied group of factors;Postoperativecomplications右半结肠癌作为结肠癌类型一种，近年来发病率显著增加。治疗期间，腹腔镜下右半结肠根治术应用率显著提高1-3。但因为附近器官解剖结构复杂以及病变位置复杂，在对其实施腹腔镜手术治疗过程中，手术入路以及术中操作均存在一定概率损伤患者腹腔内部脏器，从而对术后恢复产生影响。因此对手术入路进行优化，减轻手术操作对腹腔脏器产生的损伤，意义显著4-7。本研究选取枣庄矿业集团中心医院收治的 40 例右半结肠癌患者进行手术治疗研究，分析选择腹腔镜下中间入路手术方式和腹腔镜下回字型右下入路手术方式治疗的效果，旨在探讨腹腔镜下不同入路手术方法治疗右半结肠癌患者的有效性以及安全性。1资料与方法1.1一般资料选取 2018 年 1 月至 2020 年 12 月枣庄矿业集团中心医院收治的 40 例右半结肠癌患者作为研究对象，采用随机数字表法将其分为常规组和研究组，每组各20 例。常规组中，男 15 例，女 5 例；年龄 3279岁，平均（48