比较混合入路、中间入路行腹腔镜右半结肠癌根治术治疗右半结肠癌的近中期效果。

回顾性分析2018年6月至2024年6月行腹腔镜右半结肠癌根治术的103例结肠癌患者资料，根据手术入路不同分组，52例经混合入路患者纳入混合入路组，51例经中间入路患者纳入中间入路组。在总样本中，根据身体质量指数（BMI）筛选出肥胖患者（BMI≥28kg/m²）44例（混合入路组23例，中间入路组21例，构成肥胖亚组）；根据肿瘤位置筛选出肿瘤位于肝曲的患者41例（混合入路组21例，中间入路组20例，构成肝曲亚组），用于后续亚组分析。采用SPSS 25.0统计软件分析数据，围手术期指标等符合正态分布的计量资料以（±s）表示，组间比较行独立样本t检验；术后并发症、肿瘤无复发率等计数资料采用χ²检验。P<0.05为差异有统计学意义。

较中间入路组，混合入路组手术时间较短，术中出血量较少（P<0.05）；在肥胖或肿瘤位于肝曲亚组中，混合入路组患者手术时间短、术后排气时间短，术中出血量少（P<0.05）。两组患者术后并发症总发生率，术后1年、3年患者无病生存率比较，差异无统计学意义（P>0.05）。

混合入路与中间入路行腹腔镜右半结肠癌根治术均安全、可行，但较中间入路，混合入路手术时间较短、术中出血量较少；同时，混合入路手术有助于肥胖或肿瘤位于肝曲亚型患者的术后早期胃肠功能恢复。

To compare the short-and mid-term efficacy of laparoscopic radical resection for right-sided colon cancer using the hybrid approach versus the medial-to-lateral approach.

A retrospective analysis was performed on data from 103 patients with colon cancer who underwent laparoscopic radical resection for right-sided colon cancer from June 2018 to June 2024. Based on the surgical approach, 52 patients who underwent the hybrid approach were assigned to the hybrid approach group, and 51 patients who underwent the medial-to-lateral approach were assigned to the medial-to-lateral approach group. From the total sample, 44 obese patients (BMI ≥28kg/m²) were selected (23 in the hybrid approach group and 21 in the medial-to-lateral approach group) to form the obese subgroup; 41 patients with tumors located in the hepatic flexure were selected (21 in the hybrid approach group and 20 in the medial-to-lateral approach group) to form the hepatic flexure subgroup for subsequent subgroup analyses. Data were analyzed using SPSS 25.0 statistical software. Perioperative indicators and other measurement data with normal distribution were expressed as (±s), and inter-group comparisons were performed using independent samples t test; counting data such as postoperative complications and tumor recurrence-free rate were analyzed using χ² test. P<0.05 was considered statistically significant.

Compared with the medial-to-lateral approach group, the hybrid approach group had shorter operation time and less intraoperative blood loss (P<0.05). In the obese subgroup or the subgroup with tumors located in the hepatic flexure, the hybrid approach group showed shorter operation time, shorter postoperative exhaust time, and less intraoperative blood loss (P<0.05). There were no statistically significant differences between the two groups in the total incidence of postoperative complications or the 1-year and 3-year disease-free survival rates (P>0.05).

Both the hybrid approach and the medial-to-lateral approach are safe and feasible for laparoscopic radical resection of right-sided colon cancer. However, compared with the medial-to-lateral approach, the hybrid approach is associated with shorter operation time and less intraoperative blood loss. Additionally, the hybrid approach facilitates early postoperative gastrointestinal function recovery in patients with obesity or tumors located in the hepatic flexure.