探讨尾侧入路与尾侧中间联合入路腹腔镜右半结肠癌完整系膜切除术(CME)的临床效果。

回顾性分析2017年3月至2018年7月84例行腹腔镜下右半结肠癌CME术患者临床资料，根据手术入路不同将患者分为尾侧组45例和尾侧中间联合组39例(联合组)。选用SPSS 22.00统计软件进行数据分析。围术期各项指标、CME完成质量等计量资料以(±s)表示，采用独立样本t检验；并发症发生情况、CME完成率等计数资料采用χ²或Fisher精确检验，两组生存率比较采用Log Rank检验。P<0.05为差异有统计学意义。

联合组手术时间和术中出血量均少于尾侧组(P<0.05)；两组术后排气时间与住院时间比较差异无统计学意义(P>0.05)。尾侧组术后并发症总发生率11.1%，联合组为7.7%，两组术后并发症总发生率比较差异无统计学意义(P>0.05)。在CME完成质量方面，两组间CME完成率、系膜完整性分级、切除系膜面积、血管结扎部位、切除结肠长度、淋巴结清扫数目差异无统计学意义(P>0.05)。两组术后随访2年内均无死亡病例，联合组失访1例；2年无病生存率(DFS)比较，联合组与尾侧组差异无统计学意义(94.9% vs. 93.3%, P>0.05)。

尾侧中间联合入路腹腔镜右半结肠癌CME术在缩短手术时间和减少术中出血量方面较尾侧入路更有优势，其安全性、CME完成质量、短期疗效方面与尾侧入路基本相当。

To investigate the clinical effect of laparoscopic complete mesocolectomy (CME) for right colon cancer through caudal and medical approach.

The clinical data of 84 patients who underwent CME for right colon cancer from March 2017 to July 2018 were retrospectively analyzed. The patients were divided into caudal group (n=45) and intermediate caudal combined group (n=39) according to different surgical approaches. SPSS 22.00 statistical software was used for data analysis. Perioperative indicators, CME quality and other measurement data were expressed by (±s), independent t test was used; The incidence of complications, CME completion rate were measured by χ² or Fisher’s exact test.The survival rate of the two groups was compared by Log Rank test. P<0.05 was considered statistically significant.

The operative time and intraoperative blood loss in the combined group were less than that in the caudal group, and the difference was statistically significant (P<0.05). The total incidence of postoperative complications was 11.1% in the caudal group and 7.7% in the combined group. There was no significant difference in the total incidence of postoperative complications between the two groups (P>0.05). In terms of CME completion quality, there were no significant differences in CME completion rate, mesangial integrity grading, mesangial area excised, vascular ligation site, colon length excised, and number of lymph nodes dissected between the two groups (P>0.05). There was no death within 2 years of postoperative follow-up in both groups, and 1 case was lost to follow-up in the combined group. There was no significant difference in 2-year disease-free survival rate (DFS) between the combined group and the caudal group (94.9% vs. 93.3%, P>0.05).

CME combined with caudal median approach has more advantages than caudal approach in shortening operative time and reducing intraoperative blood loss, and its safety, CME completion quality and short-term efficacy are comparable with caudal approach.