关键词: 腹腔镜右半结肠癌D3根治术, 经尾侧联合中线入路, 中线入路, 手术指标, 术后恢复指标, 肿瘤标志物, 胃肠激素, 并发症c

Abstract: Objective To study the application effect of combined midline approach and caudal midline approach in laparoscopic right colon cancer D3 radical surgery.Methods From December 2016 to December 2021,98 patients with right colon cancer in general surgery department of Rugao People’s Hospital were randomly divided into two groups with 49 patients in each group.Both groups underwent laparoscopic D3 radical resection of right colon cancer.The control group adopted the midline approach,and the observation group adopted the caudal combined midline approach.The operation indexes (operation time,intraoperative bleeding,number of lymph nodes cleaned) and postoperative recovery indexes (time of first exhaust,time of first defecation,and hospital stay) were compared between the two groups.The levels of tumor markers [carcinoembryonic antigen (CEA),carbohydrate antigen 125 (CA125)] and gastrointestinal hormones [gastrin (GAS),motilin (MTL)] before and 2 weeks after the operation were analyzed,and the postoperative complications were counted. Results Operation time [(131.58±8.96) min], first exhaust time [(2.81±0.42) days] and first defecation time [(3.42±0.55) days] in observation group were shorter than those in control group [(142.15±9.51) min, (3.54±0.48) days, (3.99±0.61) days](P < 0.05).Two weeks after surgery, CEA and CA125 were decreased in both groups, and CEA [(9.25±1.12)ng/ml] and CA125[(28.26±2.57)U/ml] in observation group were lower than those in control group [(15.87±1.56)ng/ml, (35.98±3.13)U/ml](P< 0.05).Two weeks after operation, GAS and MTL were decreased in both groups, but GAS[(105.26±9.15)μmol/L] and MTL[(253.21±14.58)ng/L] in observation group were higher than those in control group [(100.47±8.24)μmol/L, (244.69±13.25)ng/L](P < 0.05).There was no significant difference in the total incidence of complications between the two groups (P>0.05). Conclusion Compared with the midline approach,the caudal combined midline approach can shorten the operation time,promote postoperative recovery,reduce the level of tumor markers,improve gastrointestinal function,and have high safety.

Key words: laparoscopic D3 radical resection of right colon cancer, approach via the combined midline at the tail side, middle line approach, surgical indicators, postoperative recovery index, tumor markers, gastrointestinal hormone, complication