Pommergaard Hans-Christian, Olsen Jesper Arnold, Burgdorf Stefan K, Achiam Michael Patrick
Gastroenheden, Kirurgisk Sektion, Herlev Hospital, DK-2730 Herlev, Denmark.
Ugeskr Laeger. 2010 Mar 29;172(13):1034-8.
In Denmark, we are still debating whether a laparoscopic approach is beneficial for patients scheduled for right-sided hemicolectomy. The aim of this study was to compare the outcome of laparoscopic versus open resection for right-sided colon cancer.
Using the Danish Colorectal Cancer Group (DCCG) database, we identified two groups each with 42 patients who underwent either laparoscopic right hemicolectomy (LRH) or open right hemicolectomy (ORH). The two groups were compared with respect to demographic data, length of hospital stay, number of glands harvested, blood loss, surgical complications and mortality.
The length of hospital stay was significantly shorter in the LRH group than in the ORH group (five vs. six, p = 0.023). Furthermore, the number of lymph nodes harvested was significantly larger in the LRH group than in the ORH group (23 vs. 15, p < 0.001). We found fewer anastomotic leaks (three vs. five), fewer patients with postoperative complications including anastomotic leaks (eight vs. 14) and lower operation-related mortality (zero vs. three). None of these differences were statistically significant.
LRH is comparable to ORH with regards to morbidity, mortality and blood loss. Furthermore, LRH is associated with a shorter hospital stay and a higher radical lymph node harvest than ORH. The results and the thesis that LRH will result in fewer hernias and better cosmetic outcomes makes LRH a promising surgical procedure.
在丹麦,我们仍在讨论腹腔镜手术方法对于计划接受右侧半结肠切除术的患者是否有益。本研究的目的是比较腹腔镜手术与开放性手术切除右侧结肠癌的疗效。
利用丹麦结直肠癌组(DCCG)数据库,我们确定了两组,每组42例患者,分别接受了腹腔镜右侧半结肠切除术(LRH)或开放性右侧半结肠切除术(ORH)。比较了两组患者的人口统计学数据、住院时间、采集的淋巴结数量、失血量、手术并发症和死亡率。
LRH组的住院时间明显短于ORH组(5天对6天,p = 0.023)。此外,LRH组采集的淋巴结数量明显多于ORH组(23个对15个,p < 0.001)。我们发现吻合口漏较少(3例对5例),包括吻合口漏在内的术后并发症患者较少(8例对14例),手术相关死亡率较低(0例对3例)。这些差异均无统计学意义。
LRH在发病率、死亡率和失血量方面与ORH相当。此外,与ORH相比,LRH住院时间更短,根治性淋巴结清扫率更高。LRH将减少疝气发生并获得更好的美容效果这一结果和论断,使LRH成为一种有前景的手术方法。