摘要目的 探讨中间人路腹腔镜辅助D3淋巴结廓清术治疗右半结肠癌的可行性及短期疗效.方法 2006年3月至2010年6月,对61例右半结肠癌患者施行中间人路D3淋巴结廓清手术,其中腹腔镜辅助手术(LARH组)29例,传统开腹手术(ORH组)32例.比较两组患者的淋巴结清扫数目、手术情况、术后恢复情况、并发症发生率和住院死亡率.结果 LARH组和ORH组患者淋巴结清扫数目分别为(16.9±3.8)枚和(15.4±3.6)枚,差异无统计学意义(P＞0.05).LARH组手术时间[(214.4±37.9)min]显著长于ORH组[(193.3±28.8)min,P=0.016],但术中出血量[(83.4±38.0)ml]、术后首次肛门排气时间[(44.6±20.8)h]、进流质时间[(32.5±10.6)h]、住院时间[(11.2±2.2)d]均显著少于ORH组[(192.7±43.6)ml、(70.4±80.0)h、(59.7±10.4)h和(13.8±2.8)d],两组差异有统计学意义(P＜0.05).LARH组手术并发症发生率10.4%,ORH组9.4%;两组比较,差异无统计学意义(P＞0.05).结论 右半结肠癌行腹腔镜辅助D3淋巴结廓清术,可达到与开腹相当的根治切除效果,技术上安全可行,具有创伤小、术后恢复快的优点.

abstractsObjective To explore the feasibility and short-term efficacy of laparoscopic-assisted D3 lymph node dissection for right colon cancer with a medial-to-lateral approach. Methods Clinical data of 61 patients with right colon cancer undergoing D3 lymph node dissection from March 2006 to June 2010 were analyzed retrospectively. Among them,29 underwent laparoscopic-assisted right hemicolectomy (LARH group) and 32 underwent open right hemicolectomy (ORH group). The number of lymph node harvest, operative details, and complication rate were compared between the two groups.Results The mean number of lymph node harvest did not differ significantly between the two groups (16.9±3.8 vs. 15.4±3.6). As compared to ORH group, although the operative time was significantly longer [(214.4±37.9) min vs. (193.3±28.8) min]in LARH group, the mean blood loss [(83.4±38.0) ml vs. (192.7 ±43.6) ml], time to first flatus [(44.6±20.8) h vs. (70.4±80.0) h], time to resumption of soft diet[(32.5±10.6) h vs. (59.7±10.4) h], and postoperative hospital stay [(11.2±2.2) d vs. (13.8±2.8) d]were more favorable (all P＜0.05). Complication rate was lower in LARH group (10.4% vs. 9.4%),however the difference was not statistically significant. Conclusions LARH with D3 lymph node dissection is oncologically comparable with ORH for right colon cancer. It is a safe and feasible procedure associated with rapid postoperative recovery.