Early Experience of Laparoscopic Right Hemicolectomy: A Single-Center Analysis

腹腔鏡右側大腸切除手術之早期經驗：單一醫療機構之分析

陳致一(Chih-I Chen) ； 王輝明(Hwei-Ming Wang) ； 蔣鋒帆(Feng-Fan Chiang) ； 陳明正(Ming-Cheng Chen)

《中華民國大腸直腸外科醫學會雜誌》 22卷1期 (2011/03) Pp. 13-19

https://doi.org/10.6312/SCRSTW.2011.22(1).09913

摘要

目的 近年來，以腹腔鏡方式行右側大腸根除性切除的手術日漸增加。但是從術後結果來比較，似乎並沒有達到很好的成效。方法 這是一個單一醫學中心，由單一外科團隊執行的研究。從1999年至2003年所有自門診住院接受右側大腸根除性切除以治療大腸癌的病人皆會接受評估是否符合於此一研究。急診手術及腸道完全阻塞的案例被排除在外。結果 從1999年七月到2003年七月間，一共有118位病患接受右側大腸根除性切除手術。其中使用腹腔鏡手術有84位，34位接受傳統手術。我們發現，腹腔鏡手術這組，有較高比例的男性病換，較多早期的腫瘤，較低的傷口感染率，較低的腸吻合滲漏率。但是在總手術時間上，總住院天數，跟傳統手術並無差異。腹腔鏡手術的五年存活率為61.8%，傳統手術為68.75，兩組病患的存活率在統計學上也無差異。結論 在臺灣，大腸癌病患經過完整的術前評估後，選擇性的腹腔鏡右側大腸根除性手術，為一安全且有效益的方法。

關鍵字

腹腔鏡 ； 右側大腸切除 ； 大腸直腸癌

並列摘要

Background. In recent years, the laparoscopic approach has generally been applied in right hemicolectomy, but it has not been proven to be more effective than conventional right hemicolectomy.Methods. This was a single-surgical team, single-center study. Data was prospectively recorded and retrospectively analyzed. From July 1999 to July 2003, all patients admitted via our outpatient department for elective right hemicolectomy of proved colonic malignancy were evaluated for eligibility. Cases of emergent operation and obvious sign of bowel obstruction were excluded.Results. From July 1999 to July 2003, a total of 118 patients received elective right hemicolectomy. Among them, 84 patients received the conventional method, and 34 patients received the laparoscopic method. There were more male patients, more early tumors, lower wound infection rates, and lower anastomotic leakage rates in the laparoscopic group than in the conventional group. But, there was no difference in total operative time and hospital stay between the two groups. The overall survival rates in the laparoscopic group and the conventional group were 61.8% and 68.7%, respectively, but there was no significant difference between the two groups.Conclusion. In selected patients, laparoscopic right hemicolectomy is a safe and effective method in Taiwan. Large-scale randomized controlled trials are needed to identify variables which may improve long-term survival of patients who undergo laparoscopic surgery.

並列關鍵字

Laparoscopy ； Right hemicolectomy ； Colorectal cancer