单孔腹腔镜手术治疗右半结肠癌的回顾分析

doi:10.16139/j.1007-9610.2022.01.016

摘要/Abstract

摘要：

目的:探讨经脐单孔腹腔镜在右半结肠癌根治性手术中的安全性和可行性。方法:回顾性分析2019年1月至2020年6月常熟市第二人民医院胃肠外科联合上海瑞金医院外科开展的60例腹腔镜右半结肠癌根治性手术,分为单孔法30例与传统五孔法30例。对病人的临床病例资料、手术情况、术后并发症等进行比较。结果:切口长度、术中出血量、肿瘤最大径、术后进食时间、术后拔管时间、术后住院时间、术后病理检查结果及淋巴结检出数,单孔组和五孔组比较,差异无统计学意义。单孔组与五孔组相比,手术时间[（185.17±12.28） min 比（127.83±16.70） min]长,术后第1天VAS疼痛评分[（3.30±0.79）分比（3.97±0.72）分]低,术后肛门开始排气时间[（2.70±0.54） d比（3.97±0.49） d]早,差异有统计学意义（P<0.05）。单孔组术后2例切口感染,五孔组1例,差异无统计学意义（P>0.05）。两组术后各1例吻合口漏（P>0.05）。随访（11.0±0.6）个月,两组术后均无复发,差异无统计学意义（P>0.05）。结论:单孔腹腔镜右半结肠癌根治性手术在临床疗效等方面与传统五孔腹腔镜手术相似,值得临床应用。

关键词: 右半结肠癌, 单孔腹腔镜手术, 传统五孔腹腔镜手术

Abstract:

Objective To investigate the safety and feasibility of transumbilical single-incision laparoscopy in radical operation for right colonic cancer. Methods A retrospective study was conducted in 60 patients who underwent laparosco-pic radical right hemicolectomy for colonic cancer from January 2019 to June 2020 in Department of Gastrointestinal Surgery Changshu Second People’s Hospital combined with Department of Surgery Ruijin Hospital Shanghai. The patients were divided into group of single-incision laparoscopic surgery(SILS) (n=30) and group of conventional five-port laparoscopic surgery(CLS) (n=30). Patient demographics, operative details and postoperative complications were compared between two groups. Results No significant differences were observed in length of incision, intraoperative blood loss, largest diameter of tumor, postoperative feeding time, extraction time of drainage tube, postoperative hospital stay, pathologic stage and lymph node harvest between SILS group and CLS group. Compared with CLS group, SILS group showed that all longer operative time [(185.17±12.28) min vs. (127.83±16.70) min], lower mean pain score (visual analog scale) [(3.30±0.79) vs. (3.97±0.72)] on the first postoperative day and earlier postoperative evacuation time [(2.70±0.54) d vs. (3.97±0.49) d)] with statistical significant difference (P<0.05). There were incision infections 2 cases in SILS group and 1 case in CLS group (P>0.05). One case with postoperative anastomotic leakage in both SILS group and CLS group (P>0.05). No tumor recurrence was present in 2 groups during the period of follow-up (11.0±0.6) months. Conclusions Clinical efficacy in single-incision laparoscopy would be similar to CLS for radical resection of right colonic cancer.

Key words: Right colonic cancer, Single-incision laparoscopic surgery, Conventional five-port laparoscopic surgery

中图分类号:

R735.35

邵佳哲, 周国强, 郭健, 刘坤, 赵任. 单孔腹腔镜手术治疗右半结肠癌的回顾分析[J]. 外科理论与实践, 2022, 27(01): 70-75.

SHAO Jiazhe, ZHOU Guoqiang, GUO Jian, LIU Kun, ZHAO Ren. A retrospective study on single-incision laparoscoic surgery for right colonic cancer[J]. Journal of Surgery Concepts & Practice, 2022, 27(01): 70-75.

图/表 6

图1

图2

表1

表2

表3

表4

参考文献 36

[1]	Roxburgh CS, Guillem JG. Outcomes of open vs laparoscopic rectal cancer resection[J]. JAMA Oncol, 2017, 3(1):115-116. doi: 10.1001/jamaoncol.2016.3205 URL
[2]	贺志强, 裴明祥, 张波涛, 等. 开放手术与腹腔镜手术治疗直肠癌的安全性及远期疗效比较[J]. 医学理论与实践, 2018, 31(2):215-217.
[3]	李昊天. 单孔腹腔镜结直肠手术的现状及研究进展[J]. 中国医疗器械信息, 2020, 26(8):11,103.
[4]	Ishii Y, Yahagi M, Ochiai H, et al. Short-term and midterm outcomes of single-incision laparoscopic surgery for right-sided colon cancer[J]. Asian J Endosc Surg, 2019, 12(3):275-280. doi: 10.1111/ases.12654 URL
[5]	Song Z, Li Y, Liu K, et al. Clinical and oncologic outcomes of single-incision laparoscopic surgery for right colon cancer: a propensity score matching analysis[J]. Surg Endosc, 2019, 33(4):1117-1123. doi: 10.1007/s00464-018-6370-2 URL
[6]	Yamamoto M, Asakuma M, Tanaka K, et al. Clinical impact of single-incision laparoscopic right hemicolectomy with intracorporeal resection for advanced colon cancer: propensity score matching analysis[J]. Surg Endosc, 2019, 33(11):3616-3622. doi: 10.1007/s00464-018-06647-0 pmid: 30643984
[7]	Kim CW, Hur H, Min BS, et al. Oncologic outcomes of single-incision laparoscopic surgery for right colon cancer: a propensity score-matching analysis[J]. Int J Surg, 2017, 45:125-130. doi: 10.1016/j.ijsu.2017.07.103 URL
[8]	Gibor U, Perry Z, Domchik S, et al. Single port and conventional laparoscopy in colorectal surgery: comparison of two techniques[J]. J Laparoendosc Adv Surg Tech A, 2018, 28(1):65-70. doi: 10.1089/lap.2017.0331 pmid: 28976805
[9]	盖磊, 张晓农, 张锦凌, 等. 单孔腹腔镜治疗结直肠癌的临床疗效[J]. 中国癌症防治杂志, 2017, 9(3):224-226.
[10]	王振军, 胡子龙. 直肠癌的治疗进展和看法[J]. 临床外科杂志, 2021, 29(5):409-411.
[11]	叶枫, 赵任. 机器人在结直肠癌手术中的应用[J]. 中国普通外科杂志, 2017, 26(4):401-405.
[12]	Jacobs M, Verdeja JC, Goldstein HS. Minimally invasive colon resection (laparoscopic colectomy)[J]. Surg Laparosc Endosc, 1991, 1(3):144-150. pmid: 1688289
[13]	Hohenberger W, Weber K, Matzel K, et al. Standardized surgery for colonic cancer: complete mesocolic excision and central ligation-technical notes and outcome[J]. Co-lorectal Dis, 2009, 11(4):354-364.
[14]	Bucher P, Pugin F, Morel P. Single port access laparoscopic right hemicolectomy[J]. Int J Colorectal Dis, 2008, 23(10):1013-1016. doi: 10.1007/s00384-008-0519-8 URL
[15]	李国新, 李俊蒙, 王亚楠, 等. 单孔和减孔腹腔镜结直肠癌切除术发展现状及展望[J]. 中华外科杂志, 2017, 55(7):486-490.
[16]	Jiménez-Rodríguez RM, Rubio-Dorado-Manzanares M, Díaz-Pavón JM, et al. Learning curve in robotic rectal cancer surgery: current state of affairs[J]. Int J Colorectal Dis, 2016, 31(12):1807-1815. pmid: 27714517
[17]	施毅卿, 李佑, 宋子甲, 等. 经脐单孔腹腔镜右半结肠根治手术的临床研究[J]. 中华腔镜外科杂志(电子版), 2019, 12(5):277-281.
[18]	Petrotos AC, Molinelli BM. Single-incision multiport laparoendoscopic(SIMPLE) surgery: early evaluation of SIMPLE cholecystectomy in a community setting[J]. Surg Endosc, 2009, 23(11):2631-2634. doi: 10.1007/s00464-009-0369-7 URL
[19]	Zhang H, Ling Y, Cong J, et al. Two-port laparoscopic anterior resection through a self-made glove device versus conventional laparoscopic anterior resection for rectal cancer: a comparison of short-term surgical results[J]. World J Surg Oncol, 2016, 14(1):1-9. doi: 10.1186/s12957-015-0754-8 URL
[20]	Jeon HG, Jeong W, Oh CK, et al. Initial experience with 50 laparoendoscopic single site surgeries using a homemade, single port device at a single center[J]. J Urol, 2010, 183(5):1866-1872. doi: 10.1016/j.juro.2010.01.023 URL
[21]	宋子甲, 赵任. 单孔腹腔镜在直肠癌手术的应用[J]. 结直肠肛门外科, 2020, 26(1):14-17.
[22]	Tei M, Suzuki Y, Ohtsuka M, et al. Single-port laparoscopic extended right hemicolectomy with complete mesocolic excision and central vascular ligation using a right colon rotation technique (flip-flap method)[J]. Surg Endosc, 2021, 35(9):5359-5364. doi: 10.1007/s00464-021-08500-3 URL
[23]	Hirano Y, Hattori M, Douden K, et al. The use of the EndoGrab^TM Port-Free Endocavity Retractor in single-incision laparoscopic right hemicolectomy[J]. Indian J Surg, 2017, 79(1):77-80. doi: 10.1007/s12262-016-1587-6 URL
[24]	Lee SW, Milsom JW, Nash GM. Single-incision versus multiport laparoscopic right and hand-assisted left colectomy: a case-matched comparison[J]. Dis Colon Rectum, 2011, 54(11):1355-1361. doi: 10.1097/DCR.0b013e31822c8d41 URL
[25]	Morales-Conde S, Peeters A, Meyer YM, et al. European association for endoscopic surgery(EAES) consensus statement on single-incision endoscopic surgery[J]. Surg Endosc, 2019, 33(4):996-1019. doi: 10.1007/s00464-019-06693-2 pmid: 30771069
[26]	中国医师协会结直肠肿瘤专业委员会单孔腹腔镜专委会. 单孔腹腔镜结直肠手术专家共识(2019 版)[J]. 中华结直肠疾病电子杂志, 2019, 8(4):343-348.
[27]	Nishigori H, Ito M, Nishizawa Y, et al. Postoperative chylous ascites after colorectal cancer surgery[J]. Surg Today, 2012, 42(8):724-728. doi: 10.1007/s00595-012-0132-x pmid: 22327283
[28]	陈创奇. 加速康复外科理念下胃肠道手术放置引流管的争议与对策[J]. 消化肿瘤杂志(电子版), 2017, 9(4): 234-239.
[29]	Milone M, Elmore U, Allaix ME, et al. Fashioning enterotomy closure after totally laparoscopic ileocolic anastomosis for right colon cancer: a multicenter experience[J]. Surg Endosc, 2020, 34(2):557-563. doi: 10.1007/s00464-019-06796-w pmid: 31011862
[30]	Ishizaki T, Katsumata K, Enomoto M, et al. Comparison of intra-abdominal infection risk between intracorporeal and extracorporeal anastomosis in laparoscopic right hemicolectomy for colon cancer: a single-center retrospective study[J]. Am Surg, 2021, 87(3):341-346.
[31]	Choi BJ, Kwon W, Baek SH, et al. Single-port laparoscopic Deloyers procedure for tension-free anastomosis after extended left colectomy or subtotal colectomy: a 6-patient case series[J]. Medicine (Baltimore), 2020, 99(31):e21421. doi: 10.1097/MD.0000000000021421 URL
[32]	Dapri G, Bascombe N, Montorsi M. Eight different types of laparoscopic intracorporeal anastomoses during suprapubic single-incision right hemicolectomy-a video vignette[J]. Colorectal Dis, 2021, 23(7):1942-1944. doi: 10.1111/codi.15677 URL
[33]	Bollo J, Salas P, Martinez MC, et al. Intracorporeal versus extracorporeal anastomosis in right hemicolectomy assisted by laparoscopy: study protocol for a randomized controlled trial[J]. Int J Colorectal Dis, 2018, 33(11):1635-1641. doi: 10.1007/s00384-018-3157-9 pmid: 30191370
[34]	Chang TC, Lin EK, Lu YJ, et al. Single-incision robotic colectomy versus single-incision laparoscopic colectomy: a matched case control study[J]. Asian J Surg, 2021, 44(5):749-754. doi: 10.1016/j.asjsur.2020.12.017 URL
[35]	Bae SU, Jeong WK, Baek SK. Reduced-port robotic total mesorectal resection for rectal cancer using a single-port access: a technical note[J]. Wideochir Inne Tech Maloinwazyjne, 2017, 12(4):378-384.
[36]	汤思哲, 王仆, 孔大陆. 达芬奇机器人手术系统结直肠癌根治术的现状和展望[J]. 中国肿瘤临床, 2019, 46(7):370-374.

组别	年龄（岁）	体质量指数（kg/m²）	基础疾病（n）			ASA评分
组别	年龄（岁）	体质量指数（kg/m²）	高血压	糖尿病	冠心病	ASA评分
单孔组	62.77±8.93	22.98±2.86	6	7	3	1.80±0.61
五孔组	63.70±7.09	22.88±2.25	7	7	2	1.77±0.43
t/χ²值	0.448	0.147	0.277			0.245
P值	0.656	0.884	0.871			0.808

组别	手术时间（min）	术中出血量（mL）	切口长度（cm）	肿瘤最大径（cm）	淋巴结检出数（枚）	病理分期（n）
组别	手术时间（min）	术中出血量（mL）	切口长度（cm）	肿瘤最大径（cm）	淋巴结检出数（枚）	Ⅰ期	Ⅱ期	Ⅲ期
单孔组	185.17±12.28	102.33±53.74	4.57±0.73	3.44±1.16	19.37±5.61	4	16	10
五孔组	127.83±16.70	77.00±49.42	4.77±0.57	3.95±1.08	19.43±4.63	2	13	15
t/χ²值	15.151	1.901	1.186	1.751	0.050			1.977
P值	<0.01	0.062	0.241	0.085	0.960			0.372

组别	开始排气时间（d）	饮水时间（d）	进食流质时间（d）	进食半流质时间（d）	拔引流管时间（d）	术后住院时间（d）
单孔组	2.70±0.54	1.33±0.48	4.30±0.47	6.67±0.76	7.90±0.89	9.60±0.68
五孔组	3.97±0.49	1.57±0.50	4.27±0.52	6.37±0.56	7.53±0.63	9.47±0.68
t/χ²值	9.562	1.837	0.261	1.748	1.850	0.762
P值	<0.001	0.071	0.795	0.086	0.070	0.449

组别	VAS疼痛评分（分）	并发症（n）
组别	VAS疼痛评分（分）	切口感染	吻合口漏
单孔组	3.30±0.79	2（6.67%）	1
五孔组	3.97±0.72	1（3.33%）	1
t/χ²值	3.409	0.00	0.00
P值	0.001	>0.05	>0.05