手术操作步骤在右侧结肠癌根治性切除术中的重要性

Importance of Surgical Technique in Radical Resection of Cancer of the Right Colon.

目的:评估不同操作步骤的结肠癌根治手术对远期疗效的影响。对象与方法:将1981年1月至1996年12月收治的249例右侧结肠癌患者随机分成两组:一组手术从游离大网膜开始,在横结肠系膜根部上缘和胰腺下缘处分离出结肠右血管,在其根部结扎断离并清除血管根部淋巴结,最后游离肿瘤肠段(简称A组);另一组则直接分离出肿瘤肠段,沿系膜至结肠右血管根部予以结扎断离,清除血管根部淋巴结,再游离大网膜(简称B组)。249例患者中,A组98例,B组151例。结果:两组病例在肿瘤大体类型、组织学分类、恶性程度和肿瘤分期上均无统计学差异。A组术后一年内无复发,3年复发11例(11.22％),5年生存率为81.20％±3.67％;B组术后一年内复发18例(11.92％),3年复发38例(25.17％),5年生存率为64.76％±2.92％,两组相比差异显著(P<0.05)。结论:手术操作步骤在癌肿根治性切除术中占有重要地位,A组手术操作技术能明显提高生存率,降低复发率,值得推广应用。

Objective: To compare the long term results of two different techniques of radical resection for can-cer of the right colon. Methods: From Jan. 1981 through Dec. 1996, 249 cases of right colon cancer were treated randomly by two different techniques of radical right hemicolectomy. In group A (98 ca-ses), dissection started from the great omentum in order to expose the root of superior mesenteric ves-sels between in inferior border of the pancreas and the superior border of the root of transverse meso-colon; the right and middle colonic veins and arteries were separately ligated and divided at the very beginning, curage of the lymph nodes was then performed; and division and resection of the right car-ried out at the end. In group B (151 cases), mobilization of the right colon was the first step; then the ligation and division of the right colonic vessels; lymph nodes curage followed by the resection of the transverse and right colon. Results: The 2 groups were comparable in terms of morphologic patterns, histological types and pathological staging. In group A, there was no recurrence within one year, 11 cases(11.22%) recurred after 3 years and the 5-year survival rate was 81.20%±3.67%. In group B, 18 ca-ses(11.92%) recurred within one year, another 38 cases(25.17%) recurred within 3 years and the 5-year survival rate was 64.76%±2.92%. Conclusions: Surgical technique plays an important role in curative resections. The operative procedure used in group A is safe and effective, it is to be highly recommen-ded in curative resections of the right colon.