摘要
目的比较腹腔镜辅助与开腹手术行右半结肠切除术的临床疗效。方法选择行右半结肠切除术患者230例，采用随机数字表法分为腹腔镜组115例、开腹组115例，腹腔镜组患者给予腹腔镜辅助手术，开腹组患者则给予开腹手术，比较两组相关临床指标、术后并发症、生活质量与随访情况。结果腹腔镜组手术时间、淋巴结清扫个数、医疗总费用分别为（120．75±28．20）min、（15．89±3．83）个、（4．51±0．72）万元，开腹组分别为（110．44±23．58）min、（11．14±4．01）个、（3．71±0．69）万元，两组差异均有统计学意义（t=3．008、9．186、8．603，均P〈0．01）；腹腔镜组术中出血量、切口长度、肠道排气时间、流质饮食时间、术后引流时间、术后镇痛时间、术后留置导尿时间、住院时间分别为（91．23±14．85）mL、（5．85±2．32）em、（3．47±1．55）d、（4．80±2．12）d、（6．31士3．21）d、（5．0l±1．75）h、（3．25±1．07）d、（15．37±4．41）d，均显著低于、短于开腹组的（121．63±12．32）mL、（15．05±7．72）cm、（4．62±1．68）d、（7．43±2．58）d、（7．67±2．80）d、（9．51±3．54）h、（6．20±2．33）d、（22．62±5．39）d（t=16．895、12．238、5．395、8．446、3．424、12．220、12．338、11．163，均P〈0．01）；腹腔镜组并发症发生率为1．74％，显著低于对照组的14．78％（x。=12．908，P〈0．01）；腹腔镜组术后1个月各维度生活质量评分均显著高于开腹组（均P〈0．01）；两组随访9个月肿瘤局部复发、转移等差异均无统计学意义（均P〉0．05）。结论腹腔镜辅助的右半结肠切除术对患者创伤更小，术后恢复更快，并发症发生率更低，术后患者生活质量高于开腹手术，但医疗费用相对昂贵。
Objective To investigate the efficacy of laparoscopic assisted and open surgery for right colectomy. Methods 230 patients underwent right colectomy were selected, and they were randomly divided into laparoscopic group and laparotomy group according to the digital table, each group in 115cases. The laparoscopic group was treated with laparoscopic assisted operation. The laparotomy group was treated with open surgery. The complications after operation, the quality of life and follow up were compared between the two groups. Results The operation time, number of lymph node dissection and total cost of the laparoscopic group were （120.75 ± 28.20）min, （15.89 ± 3.83 ）, （4.51 ± 0. 72） million,respectively,which of the laparotomy group were （ 110.44 ± 23.58） min, （ 11.14 ± 4.01 ）, （3.71 ± 0. 69 ） million, respectively, the differences were statistically significant （ t = 3. 008,9.186,8. 603, all P 〈 0.01 ）. The intraoperative blood loss and incision length of the laparoscopic group were （91.23 ± 14.85 ） mL and （5.85 ±2.32） cm, respectively,which were significantly lower than those of the laparotomy group [ （121.63 ± 12.32）mL, （15.05± 7.72） cm,t = 16. 895,12. 238, all P 〈 0. 01 ]. The bowel exhaust time, fluid time, postoperative drainage time, postoperative analgesia time, postoperative catheterization time and hospitalization time of the laparoscopic group were （3.47 ± 1.55）d,（4.80 ±2.12）d,（6.31 ±3.21）d,（5.01 ± 1.75）h,（3.25 ± 1.07）d,（15.37 ±4.41） d,respectively, which were significantly shorter than those of the laparotomy group [ （4.62 ±1.68 ） d, （7.43 ±2.58 ） d, （ 7.67±2. 80） d, （9.51 ± 3.54） h, （6.20 ± 2.33 ） d, （ 22.62 ± 5.39 ） d, t = 16. 895,12. 238,5. 395,8. 446,3. 424,12. 220,12.338,11. 163 ,all P 〈0.01 ]. The incidence rate of complication in the laparoscopic group was 1.74% ,which was significantly lower than 14.78% in the laparotomy group（ Xz = 12.908 ,P 〈0.01 ）. The scores of quality of life in the laparoscopic group were significantly higher than those in the laparotomy group（ all P 〈0.01 ）. The two groups were followed up for 9 months, the local recurrence, metastasis and other differences were not statistically significant （all P 〉 0.05 ）. Conclusion Laparoscopic assisted right colectomy has less wounded in patients, faster recovery after operation, lower incidence of complications, higher quality of life, but relatively expensive medical expenses.
作者
张建立
李孟彬
Zhang JL Li MB(Department of General Surgery,the People＇s Hospital of Houma , Houma , Shanxi 043000, China Department of Digestive Diseases, X~iing Hospital of Digestive Diseases, Affiliatied to the Fourth Military Medical University, Xi＇an, Shanxi 710032, China（)
出处
《中国基层医药》
CAS
2017年第21期3205-3208,共4页
Chinese Journal of Primary Medicine and Pharmacy
基金
山西省卫生厅科研课题（2014011004）
