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中华普外科手术学杂志(电子版) ›› 2022, Vol. 16 ›› Issue (05) : 495 -498. doi: 10.3877/cma.j.issn.1674-3946.2022.05.008

论著

不同入路在腹腔镜结直肠癌手术中结肠脾曲游离的临床效果
蔡斌1, 姚春和1, 董朝妮1, 杨振林1, 张海鹏2,(), 侯翔波2, 乔庆3   
  1. 1. 712000 陕西咸阳,延安大学咸阳医院普外科
    2. 710003 西安,陕西省中医医院普外科
    3. 710038 西安,空军军医大学第二附属医院普外科
  • 收稿日期:2021-07-08 出版日期:2022-10-26
  • 通信作者: 张海鹏

Clinical effect of different approaches in colonic splenic flexure dissociation in laparoscopic colorectal cancer surgery

Bin Cai1, Chunhe Yao1, Chaoni Dong1, Zhenlin Yang1, Haipeng Zhang2,(), Xiangbo Hou2, Qing Qiao3   

  1. 1. Department of General Surgery, Xianyang Hospital of Yan’an University, Xianyang Shaanxi Province 712000, China
    2. Department of General Surgery, Shaanxi Hospital of Traditional Chinese Medicine, Xi’an Shaanxi Province 710003, China
    3. Department of General Surgery, the Second Affiliated Hospital of Air Force Military Medical University, Xi’an Shaanxi Province 710038, China
  • Received:2021-07-08 Published:2022-10-26
  • Corresponding author: Haipeng Zhang
  • Supported by:
    Shaanxi Provincial Science and Technology Research and Development Program(2020K11-03-03-03); Key Research and Development Program of Shaanxi Province(2019SF-087); Scientific Research Program of Education Department of Shaanxi Province(20JK0903)
引用本文:

蔡斌, 姚春和, 董朝妮, 杨振林, 张海鹏, 侯翔波, 乔庆. 不同入路在腹腔镜结直肠癌手术中结肠脾曲游离的临床效果[J/OL]. 中华普外科手术学杂志(电子版), 2022, 16(05): 495-498.

Bin Cai, Chunhe Yao, Chaoni Dong, Zhenlin Yang, Haipeng Zhang, Xiangbo Hou, Qing Qiao. Clinical effect of different approaches in colonic splenic flexure dissociation in laparoscopic colorectal cancer surgery[J/OL]. Chinese Journal of Operative Procedures of General Surgery(Electronic Edition), 2022, 16(05): 495-498.

目的

探讨不同入路在腹腔镜结直肠癌手术中结肠脾曲游离的临床效果。

方法

前瞻性选取2018年1月至2020年12月结直肠癌患者116例,采用随机数字表法将患者分为对照组和研究组,每组各58例。两组患者均行腹腔镜结直肠癌根治术,对照组:采用传统的侧方入路手术,研究组:采用中间入路“四步法”手术。数据应用软件SPSS 22.0处理。围手术期相关指标等计量资料采用(

xˉ
±s)表示,行独立样本t检验;并发症情况等计数资料行χ2检验;生存分析采用Kaplan-Meier法,行Log-Rank检验。P<0.05为差异有统计学意义。

结果

研究组患者手术时间、术中出血量、术后排气时间、恢复流质饮食时间及术后住院时间均较对照组均显著减少,淋巴结清扫数目显著增多,差异均有统计学意义(P<0.05)。研究组总并发症发生率显著较对照组低(6.9% vs.20.7%,P<0.05)。患者术后随访5~41个月,中位随访时间28个月,两组患者累积总生存率及无病生存率比较差异无统计学意义(P>0.05)。

结论

腹腔镜结直肠癌根治术中结肠脾曲游离采用中间入路“四步法”,不仅具有手术时间缩短、术中出血少、术后恢复快、淋巴结清扫更彻底等优势,还可以有效降低并发症发生的风险,手术安全性更高。

Objective

To investigate the Clinical effect of different approaches in laparoscopic colorectal cancer surgery.

Methods

116 cases of colorectal cancer patients in our hospital from January 2018 to December 2020 were selected. The patients were divided into control group and study group according to random number table,each of 58 cases. Laparoscopic radical resection of colorectal cancer was performed in both groups,the control group was treated with traditional lateral approach,and the study group was treated with “four-step” technique through the middle approach. The data were processed by SPSS 22.0. The measurement data of perioperative related indicators were expressed by(

xˉ
±s),and independent t test was performed;Complication count column χ2 inspection;Kaplan-Meier method and Log-Rank test were used for survival analysis. P<0.05 was statistically significant.

Results

Compared with the control group,the perioperative operation time,intraoperative blood loss,postoperative exhaust time,recovery of fluid diet time and postoperative hospital stay of the study group were significantly reduced,and the number of lymph node dissection was significantly increased,with statistically significant differences(P<0.05). The incidence of total complications in the study group was significantly lower than that in the control group(6.9% vs.20.7%,P<0.05). Postoperative follow-up was 5~41 months,with a median follow-up of 28 months. There was no statistical significance in cumulative overall survival and disease-free survival between the two groups(P>0.05).

Conclusion

The application of the middle approach “four-step method” in the separation of splenic curvature of colon in laparoscopic radical resection of colorectal cancer not only has the advantages of short operation time,less intraoperative bleeding,quick postoperative recovery and more thorough lymph node dissection,but also can effectively reduce the risk of complications,and the safety of the operation is higher.

表1 116例结直肠癌手术不同入路两组患者一般资料比较[(
xˉ
±s),例]
表2 116例结直肠癌手术不同入路两组患者围手术期相关指标比较(
xˉ
±s)
表3 116例结直肠癌手术不同入路两组患者并发症发生情况比较[例(%)]
图1 116例结直肠癌手术不同入路两组患者累积总生存曲线及无病生存曲线
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