不接触隔离技术在预防大肠癌肝转移中的作用

PREVENTION ROLE OF NO TOUCH ISOLATON TECHNIQUE IN LIVER METASTASIS OF COLON CANCER

目的 评价不同操作步骤的大肠癌根治手术对大肠癌肝转移的影响。方法 将 1990～ 1995年收治的 80例大肠癌患者随机分成两组 :A组手术采用不接触隔离技术 (Non Touch Isolation Technic)即 :首先隔离受累结肠的肠腔 ,由根部结扎、切断供应受累结肠的淋巴血管蒂 ,最后才将受累肠段和相应的肠系膜整快切除 ;B组则直接分离出肿瘤肠段 ,将此段肠管及相应系膜直接切除 ,不隔离肠腔、不由根部处理淋巴血管蒂。 80例患者中 ,A组 31例 ,B组 49例。结果 两组患者肿瘤大体类型、组织学分类、恶性程度和肿瘤分期上均无统计学差异。A组 3年肝转移 6例 (6 / 31) ;B组 3年肝转移 15例 (15 / 49)。两组相比差异显著 (P<0 .0 5 )。结论 手术操作步骤在大肠癌根治性手术中占有重要地位 ,不接触隔离技术能明显降低肝转移率 ,值得推广应用。

To evaluate the influence of different techniques in radical operation of colon cancer on the liver metastasis.Methods 80 patients administered from 1990 to 1995 were randomized into two groups:No touch isolation technique was applied in group A(firstly,isolation lumen of target bowel,ligation and cutting off the lymph and blood vessel pedicel from the radicel,then removal the whole target colon and mesentery);routine operation was applied in group B(separating and cutting off the target bowels and mesentery directly,no isolation of bowel lumen,no ligation and cutting off the lymph and blood vessel pedicel from the radicel).There was 31 patients in group A,49 patients in group B.Results There was no significant statistic difference of general type,patholgical type,malignant grade and TNM staging between two groups.There were 6 patients(6/31)in group A and 15 patients(15/49)suffered from liver metastasis during 3 years after operation(with significant statistic difference,P<0.05).Conclusion Adequate techniques in radical operation of colon cancer is very important.No touch isolation technique can significantly decrease the liver metastaic rate and should be applied abroad.