临床普外科电子杂志 ›› 2025, Vol. 13 ›› Issue (3): 41-.

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比较腹腔镜中间入路、尾内侧入路单向环路式手术在右半结肠癌患者中的效果及安全性

  

  1. 玉林市第三人民医院 外科一病区,广西 玉林 537000
  • 出版日期:2025-07-01 发布日期:2025-11-20

Comparison of the effect and safety of laparoscopic middle approach and caudal medial approach in one-way loop surgery in patients with right colon cancer

  1. Ward 1 Surgical Department of Yulin Third People's Hospital, Guangxi Yulin 537000, China
  • Online:2025-07-01 Published:2025-11-20

摘要:

目的 研究右半结肠癌手术中分别应用腹腔镜中间入路、尾内侧入路单向环路式手术的效果与安全性。方法 选择 2022 年 4 月至 2024 年 4 月玉林市第三人民医院收治的 85 例右半结肠癌患者,所有患者均接受右半结肠癌根治术。依据入路方式不同分为对照组和观察组。对照组(n=42)采用腹腔镜中间入路手术,观察组(n=43)实行腹腔镜尾内侧入路单向环路式手术,比较两组围手术期指标、肿瘤标志物、应激指标及并发症发生情况。结果 观察组淋巴结清扫数目多于对照组,且手术时间短于对照组,且术中出血量少于对照组,差异均有显著性(P < 0.05)。术后,观察组患者的癌胚抗原、糖类抗原 125、糖类抗原 19-9、皮质醇、促肾上腺皮质激素、去甲肾上腺素均低于对照组,差异均有显著性(P < 0.05)。观察组中转开腹率(0 比 9.52%)、总并发症发生率(6.98% 比 23.81%)低于对照组,差异均有显著性(P < 0.05)。结论 尾内侧入路单向环路式腹腔镜右半结肠癌手术所需时间更短,术中出血量少,应激指标水平更优,更利于患者术后恢复,且手术野清晰,可避免反复翻动系膜、肠管,更利于完成淋巴结清扫。

关键词: 右半结肠癌, 腹腔镜结肠癌根治术, 尾内侧入路单向环路, 中间入路

Abstract:

Objective To study the effect and safety of laparoscopic middle approach and caudal medial approach in the operation of right colon cancer. Method 85 patients with right colon cancer in Yulin Third People's Hospital from April 2022 to April 2024 were selected. All patients received radical resection of right colon cancer. They were divided into control group and observation group according to different approaches. The control group (n=42) was treated with intermediate approach surgery, and the observation group (n=43) was treated with oneway loop surgery via caudal medial approach. The perioperative indicators, tumor markers, stress indicators and complications of the two groups were compared. Result The number of lymph node dissection in the observation group was more than that in the control group, and the operation time was shorter than that in the control group, and

the intraoperative blood loss was less than that in the control group, the differences were significant (P < 0.05). After operation, the carcinoembryonic antigen, carbohydrate antigen 125, carbohydrate antigen 19-9, cortisol, adrenocorticotropic hormone, norepinephrine in the observation group were signifi cantly lower than those in the control group (P < 0.05). The conversion rate of laparotomy (0 vs 9.52%) and the total complication rate (6.98% vs 23.81%) in the observation group were lower than those in the control group, and the differences were significant (P < 0.05). Conclusion The medial caudal approach of one-way loop laparoscopic surgery for right colon cancer needs shorter time, less intraoperative blood loss, which is more conducive to the postoperative recovery of patients, and the operation idea is clear, which can avoid repeated overturning of the mesentery and intestines, and is more conducive to the completion of lymph node dissection.

Key words: Right colon cancer, Laparoscopic radical resection of colon cancer, One way loop via caudal medial approach, Intermediate approach