完整结肠系膜切除在进展期结肠癌的应用研究

Applied research of complete mesocolon resection for advanced colon cancer

目的 探讨完整结肠系膜切除（complete mesocolic excision,CME）在进展期结肠癌患者手术治疗的应用价值.方法 总结分析我院胃肠外科本手术治疗小组2011年1月~2012年12月期间确诊为结肠癌II~III期患者行CME手术治疗（CME组43例）的临床资料,回顾性对比同一手术组2009年1月~2010年12月期间确诊为结肠癌II期至III期患者行传统根治术（对照组46例）的临床资料,对比两组手术效果.结果 CME组与对照组比较,II期患者淋巴结清扫数目差异无统计学意义（P〉0.05）;III期患者淋巴结清扫数目及阳性淋巴结数目差异均有统计学意义（P〈0.01）;平均手术时间,术后排气、排便时间差异均无统计学意义（P〉0.05）;术中出血量差异有统计学意义（P〈0.01）.结论 进展期结肠癌采用CME方法,符合肿瘤操作原则及现代外科精细操作的要求,不增加平均手术时间、手术风险及并发症的发生率,显著提高III期患者的根治效果.

Objective To explore the value of complete mesocolon resection （complete mesocolic excision, CME） in the surgical treatment of patients with advanced colon cancer. Methods Analyzed the clinical data of the patients diagnosed with co- lon cancer Phase II to Phase III and lined CME surgical treatment （43 cases） form the January 2011 to December 2012 ,and retro- spectively analyzed same surgery group January 2009 to December 2010 to patients with Phase II to Phase III clinical data to con- ventional radical surgery （the control group, n = 46）, surgical results were compared. Results For the patients in Phase II, CME group compared with the control group, lymph node dissection number of CME group was（ 17.9 ±1.8）, the control group was （ 17.3± 1.7）, the difference was not statistically significant （ P 〉 0.05 ）, for the patients in phase III, the number of Lymph node dissection of CME group was （23.4±2.7 ）, the number of positive lymph nodes was （5.2± 1.8）, the number of lymph node dissection of the control group was （ 18.8 ± 2.9）, the number of positive lymph nodes was （3.3 ± 1.9）, lymph nodes were statisti- cally significant differences in cleaning of the number and the number of positive lymph nodes （ P 〈 0. 01 ）. The mean operative time, postoperative exhaust, defecation time were not statistically significant （P 〉 0. 05） ; the blood loss of CME group were（68. 8 ± 19.4）ml, the control group were（ 125.5 ± 17.5）ml , the difference were statistically significant （P 〈0. 01 ）. Conclusion Advanced colon cancer controlles by CME methods, it is in line with the requirements of the tumor operation principles and modem fine surgical operation might not increase the average incidence of operative time, surgical risks and complications, and significant- ly improves patients with stage III radical effect.