中间入路腹腔镜全系膜切除术治疗右半结肠癌的临床疗效

Clinical efficacy of laparoscopic complete mesorectal excision with a medial-to-lateral approach for right colonic cancer

目的 探讨中间入路腹腔镜全结肠系膜切除术（CME）治疗右半结肠癌的临床疗效及安全性和可行性.方法 回顾性分析2010年1月至2013年10月广东省佛山市顺德区龙江医院收治的46例右半结肠癌患者的临床资料,其中24例患者行中间入路腹腔镜CME为腹腔镜组,22例患者行开腹CME为对照组.比较两组患者术中、术后情况及肿瘤复发情况.患者术后定期门诊和电话随访,随访时间截至2014年4月.计量资料采用t检验,计数资料采用x2检验和Fisher确切概率法检验.结果 两组患者均顺利完成手术.腹腔镜组与对照组患者手术时间分别为（130±26） min、（156±32） min,术中出血量分别为（105±29） mL、（136 ±35） mL,两组比较,差异有统计学意义（t=6.070,3.310,P＜0.05）;淋巴结清扫数目分别为（19±4）枚、（18±4）枚,切除标本长度分别为（28.0±2.5）cm、（26.8 ±2.3）cm,两组比较,差异无统计学意义（=0.560,1.770,P＞0.05）;术后肛门排气时间分别为（2.9 ±0.8）d、（3.8 ±0.9）d,术后住院时间分别为（12.3 ±2.7）d、（14.1 ±2.2）d,两组比较,差异有统计学意义（t=3.880,2.400,P＜0.05）.两组患者均未发生手术相关并发症.46例患者均获得随访,平均随访时间为15个月（6～24个月）.随访期间4例患者发生肿瘤局部复发,其中腹腔镜组2例（2/24）,对照组2例（2/22）,两组比较,差异无统计学意义（P＞0.05）.随访期间无患者死亡.结论 右半结肠癌行中间入路腹腔镜CME是安全可行的,其近期疗效满意.

Objective To investigate the safety and efficacy of laparoscopic complete mesocolic excision （CME） with a medial-to-lateral approach for the treatment of right colonic cancer.Methods The clinical data of 46 patients with right colonic cancer who were admitted to the Longjiang Hospital from January 2010 to October 2013 were retrospectively analyzed.Twenty-four patients who received laparoscopic CME were in the laparoscopic group,and the other 22 patients who received open CME were in the control group.The intra-and postoperative condition and tumor recurrence of the 2 groups were compared.Patients were followed up till April 2014 after the operation.The measurement data were analyzed using the t test,and the count data were analyzed using the chi square test or Fisher exact probability.Results The operation was successfully done in the 2 groups.The operation time and intraoperative blood loss were （130 ± 26） minutes and （105 ± 29） mL in the laparoscopic group,and （156 ± 32）minutes and （136 ± 35）mL in the control group,with significant differences between the 2 groups （t =6.070,3.310,P〈0.05）.The numbers of lymph nodes resected and lengths of resected specimen were 19 ± 4 and （28.0 ± 2.5）cm in the laparoscopic group,and 18 ± 4 and （26.8 ± 2.3）cm in the control group,with no significant differences between the 2 groups （t =0.560,1.770,P 〉0.05）.The postoperative exhaust time and duration of postoperative hospital stay were （2.9 ±0.8）days and （12.3 ±2.7） days in the laparoscopic group,and （3.8 ±0.9）days and （14.1 ±2.2） days in the control group,with significant differences between the 2 groups （t =3.880,2.400,P 〈 0.05）.No operation-related complications was detected in the 2 groups.Forty-six patients were followed up for a mean time of 15 months （range,6-24 months）.Two patients in the laparoscopic group and 2 in the control group were complicated with tumor local recurrence,with no significant difference between the 2 groups （P 〉 0.05）.No patients died during the follow-up.Conclusion Laparoscopic complete mesorectal excision with a medial-to-lateral approach for right colonic cancer is safe and feasible with satisfactory short-term outcome.