贵州医科大学学报

2019, v.44;No.231(12) 1438-1442

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侧方入路与横向入路法在腹腔镜左半结肠癌根治术中的应用效果
Comparison of Lateral and Transverse Approaches in Laparoscopic Left Hemicolectomy

王海啸;钱燕;侯国伟;陶国全;
WANG Haixiao;QIAN Yan;HOU Guowei;TAO Guoquan;Department of Gastrointestinal Surgery, the Affiliated Huaian First People's Hospital of Nanjing Medical University;

摘要(Abstract):

目的:探讨侧方入路与横向入路方式在腹腔镜左半结肠癌根治术中的应用效果。方法:72例左半结肠癌患者随机均分为常规组和观察组,常规组采用侧方入路行腹腔镜左半结肠癌根治术,观察组采用横向入路法行腹腔镜左半结肠癌根治术,对比2组患者的手术时间、术中出血量、住院时间、并发症发生率;于手术前及手术后第5天时取血,检测2组患者血清凋亡抑制因子(Livin)、X连锁凋亡抑制蛋白(Xiap)、Polo样激酶(Plk1)、胸腺激酶(TK1)、癌胚抗原(CEA)及糖类抗原19-9(CA19-9)水平,比较2组患者术中及术后并发症(切口感染、腹腔出血、吻合口瘘、胰腺损伤及脾脏损伤)。结果:观察组患者的手术时间显著短于常规组,术中出血量、术后引流量显著少于常规组,淋巴结清扫数显著多于常规组(P<0.05);术后第5天时,2组患者血清Xiap、TK1、Livin、Plk1、CEA及CA19-9水平均较术前显著降低,观察组患者TK1、Livin、CEA及CA19-9水平显著低于常规组,差异有统计学意义(P<0.05);常规组术中及术后并发症总发生率显著高于观察组(P<0.05)。结论:相比侧方入路,在腹腔镜左半结肠癌根治术采用横向入路法能够提高淋巴结清扫数,并且手术耗时更短,术中出血更少,术后并发症发生率更低。
Objective: To explore the application effect of lateral approach and lateral approach in the radical laparoscopic resection of left colonic cancer. Methods: 72 patients with left colonic cancer were randomly divided into two groups. Group A received radical laparoscopic left hemicolectomy via lateral approach, and Group B received radical laparoscopic left hemicolectomy via transverse approach. The operation time, intraoperative bleeding volume, hospitalization time, complication rate and the levels of apoptosis inhibitor(Livin), X-linked apoptosis suppressor protein(XIAP), polo like kinase(Plk1), thymus kinase(TK1), carcinoembryonic antigen(CEA) and carbohydrate antigen 19-9(CA19-9) were compared between the two groups. Results: The operation time of Group B was significantly shorter than that of Group A. The amount of bleeding and postoperative drainage were significantly less than those of Group A, and the number of lymph node dissection was significantly more than that of Group A(P<0.05). The total incidence of complications in Group A was significantly higher than that in Group B(P<0.05). The levels of XIAP, TK1, Livin, Plk1, CEA and CA19-9 in the two groups were significantly lower after operation than those before operation, and the levels of TK1, Livin, CEA and CA19-9 in Group B were significantly lower than those in Group A(P<0.05). Conclusion: Compared with the lateral approach, the transverse approach in laparoscopic left hemicolectomy can improve the number of lymph node dissection, and take up less time, with less intraoperative bleeding volume, and lower incidence of complications.

关键词(KeyWords): 左半结肠癌根治术;腹腔镜;横向入路;侧方入路;结肠癌
left hemicolectomy;laparoscopy;transverse approach;lateral approach;colonic cancer

Abstract:

Keywords:

基金项目(Foundation): 国家自然基金项目(81802917)

作者(Author): 王海啸;钱燕;侯国伟;陶国全;
WANG Haixiao;QIAN Yan;HOU Guowei;TAO Guoquan;Department of Gastrointestinal Surgery, the Affiliated Huaian First People's Hospital of Nanjing Medical University;

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DOI: 10.19367/j.cnki.1000-2707.2019.12.014

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