Comparison of short- and medium-term results between laparoscopically assisted and totally laparoscopic right hemicolectomy: a case-control study
Comparison of short- and medium-term results between laparoscopically assisted and totally laparoscopic right hemicolectomy: a case-control study
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DOI：
10.1007/s00464-010-0902-8
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发表时间：
2010-09-01
影响因子：
3.1
通讯作者：
Nardi, Mario, Jr.
中科院分区：
文献类型：
--
作者：
Fabozzi, Massimiliano;Allieta, Rosaldo;Nardi, Mario, Jr.
背景本研究的目的是比较短期和中期的结果完全腹腔镜右结肠切除术（TL）与腹腔镜辅助右结肠切除术（LAC）治疗右半结肠cancer.Methods一项回顾性研究比较两个无统计学差异的组（50 TL和50 LAC例）管理的非转移性恶性肿瘤。研究结局包括手术时间、小切口手术时间、术中并发症、术后疼痛、胃肠道功能恢复时间、腹腔引流持续时间、镇痛治疗持续时间、术后并发症、住院时间、采集的淋巴结数量，结果TL组平均手术时间78 ± 25 min，LAC组平均手术时间92 ± 22 min（P < 0.05）。结果显示，TL组术后疼痛程度较低，镇痛药用量减少（p > 0.05），消化功能恢复较早。平均住院时间约为5天（TL）和7天（LAC）（p < 0.05）。术中或术后均未发生并发症，同样，TL组未发生死亡。相比之下，LAC组的并发症发生率为30%（p < 0.05）。并发症包括术中小肠病变1例，术后呼吸道感染3例，吻合口瘘3例，肠梗阻2例，小切口感染3例，术后股神经官能症1例，术后心脏病发作1例，术后胰腺炎1例。死亡率为0%。在4年的随访期间，两组都没有复发的肿瘤疾病。结论研究结果似乎表明，TL右结肠切除术是可行的，安全的，产生的结果与开放的方法，但提供改善术后患者的舒适度。这项回顾性比较研究的局限性不允许得出明确的结论，尽管下一个前瞻性随机研究的数据令人鼓舞。
Background This study aimed to compare the short- and medium-term results obtained by totally laparoscopic right colectomy (TL) with those obtained by laparoscopically assisted right colectomy (LAC) for the treatment of right colon cancer.Methods A retrospective study compared two nonstatistically different groups (50 TL and 50 LAC cases) managed for nonmetastatic malignant tumors. The study outcomes included operative time, length of minilaparotomy, intraoperative complications, postoperative pain, time to resumption of the gastrointestinal functions, permanence of abdominal drain, analgesic therapy duration, postoperative complications, hospitalization time, number of harvested lymph nodes, and distant metastases onset.Results The mean operative times were 78 +/- 25 min (TL group) and 92 +/- 22 min (LAC group) (p < 0.05). The findings showed a lower postoperative pain level associated with a reduction in analgesic consumption (p > 0.05) and earlier restoration of digestive function in the TL group than in the LAC group. The mean hospital stays were approximately 5 days (TL) and 7 days (LAC) (p < 0.05). No complications occurred either intra- or postoperatively, and similarly, the TL group experienced no mortality. In comparison, the LAC group had a 30% complication rate (p < 0.05). The complications included one case of intraoperative small bowel lesion, three cases of postoperative respiratory infections, three cases of anastomotic leakage, two cases of intestinal occlusion, three cases of minilaparotomy infection, one case of postoperative femoral neurosis, one case of postoperative heart attack, and one case of postoperative pancreatitis. The mortality rate was 0%. Neither group had a recurrence of the neoplastic disease during a 4-year follow-up period.Conclusions The findings seem to demonstrate that TL right colectomy is feasible and safe, yielding results comparable with those of the open approach but offering improved postoperative patient comfort. The limits of this retrospective comparative study do not allow definitive conclusions to be drawn despite the encouraging data for the next prospective randomized studies.