研究腹腔镜辅助下尾侧中央入路右半结肠癌扩大根治术治疗结肠肝曲癌患者的临床效果。

选取2017年1月至2019年6月均行腹腔镜辅助右半结肠癌扩大根治术的50例结肠肝曲癌患者，根据手术入路不同，按照病例匹配法将患者分为尾侧组(n＝25)和传统组(n＝25)，尾侧组行腹腔镜辅助尾侧中央入路，传统组行腹腔镜辅助传统中央入路。采用软件SPSS22.0进行统计学分析。围术期各项指标和血液炎症指标等计量资料采用(±s)表示，独立样本t检验；术后并发症等计数资料采用χ²检验；以P<0.05表示差异有统计学意义。

与传统组围术期指标相比，尾侧组手术时间、排气时间、引流管拔除时间均明显缩短，术中出血量显著减少，差异均有统计学意义(P<0.05)；术后7 d，尾侧组术后血清CRP、TNF-α、IL-6水平均显著优于中央入路组(P<0.05)；尾侧组术后并发症显著低于中央入路组(12.0% vs. 36.0%，P<0.05)；随访时间12～49个月，两组患者均无死亡发生，且均未出现复发和远处肿瘤转移。

尾侧中间入路手术治疗结肠肝曲癌患者，具有操作更简便，节约手术时间短、术中出血少、住院时间短、并发症少等优势，安全有效。

To analyze the clinical outcome of laparoscopic expanded right hemicolectomy through caudal and/or medial approach for right colon carcinoma.

Clinical data of 50 patients with colon cancers located at liver flexure who underwent laparoscopic expanded right hemicolectomy from January 2017 to June 2019 were analyzed retrospectively. According to different surgical approaches, patients were divided into caudal group (n=25) and traditional group (n=25). Patients in the caudal group received laparoscopic surgery through caudal and medial approach, while patients in the traditional group received laparoscopic surgery through medial approach. SPSS22.0 software was used for statistical analysis. Measurement data such as perioperative indexes and blood inflammation indexes were expressed by (±s), and were examined by using independent t test. The statistical data of postoperative complications was examined by using χ² test. A P value of <0.05 was considered as statistically significant difference.

Compared with the perioperative indicators in the traditional group, the operation time, exhausting time and drainage tube removal time in the caudal group were significantly shortened, and intraoperative bleeding was significantly reduced, with statistically significant differences (P<0.05). On the 7th day after surgery, the serum levels of CRP, TNF-α and IL-6 in the caudal group were significantly better than those in the traditional group (P<0.05). Postoperative complications in the caudal group were significantly lower than those in the traditional group (12.0% vs 36.0%, P<0.05). Follow-up ranged from 12 to 49 months, no perioperative death, recurrence and distant tumor metastasis occurred in both 2 groups.

Caudal/medial approach is safe and effective in laparoscopic surgery for patients with colon cancer located at liver flexure, with advantages such as simpler operation, less operative time, less intraoperative bleeding, shorter hospitalization time, and fewer complications.