完整结肠系膜切除与传统结肠癌手术的对比研究

Comparative study on complete mesocolic excision and traditional radical surgery for colon cancer

目的探讨完整结肠系膜切除（complete mesocolic excision，CME）联合中央血管结扎与传统结肠癌手术在近期疗效及复发、转移方面的差异。方法186例Ⅰ～Ⅲ期结肠癌患者，行CME联合中央血管结扎术患者99例为CME组，行传统结肠癌根治术患者87例为传统组，比较2组患者术中淋巴结清扫总数、阳性淋巴结数、手术时间、术中出血量，术后排气时间、进食时间、术后并发症发生率和复发转移率。结果CME组淋巴结清扫总数[（21．1士6．2）个]和阳性淋巴结数[4（0，10）个]明显多于传统组[（15．6±6．5）个、2（0，6）个]（P〈0．05），手术时间[（199．8±37．1）mini、术中出血量[（95．2±11．3）mL]和术后复发转移率（2．0％）明显少于传统组[（209．1±28．3）min、（118．5±18．6）mL、10．3％]，术后排气时间[3（2，4）d]、进食时间[5（4，6）d]明显短于传统组[4（2，6）d、5（4，7）d]（P〈0．05）；术后并发症发生率（14．1％）与传统组（17．2％）比较差异无统计学意义（P〉0．05）。结论CME联合中央血管结扎可提高淋巴结清扫数量、缩短手术时间、减少术中出血量，促进患者术后恢复，降低术后复发与转移，提高患者生存率，且不增加术后并发症。

Objective To study the short-term surgical outcomes of complete mesocolic excision （CME） and traditional radicalsurgery for colon cancer and the recurrence and metastasis after surgery. Methods In 186 patients with staging I to III colon cancer, 99 underwent CME plus central vessel ligation （CME group） and 87 underwent traditional radical surgery （traditional group）. The total number of dissected lymph nodes, number of positive lymph nodes, operation lasting time, intraoperative blood loss, postoperative exhaust time, time of beginning to eat, the incidence of postoperative complications and rates of recurrence and metastasis were compared between two groups. Results The total number of dissected lymph nodes （21. 1±6. 2） and positive dissected lymph nodes （4 （0, 10） in CME group were significantly more than those in traditional group （15. 6±6. 5, 2 （0, 6）） （P〈0.05）. The operation lasting time （（199.8±37.1） rain） was shorter, intraoperative blood loss （（95.2±11.3） mL） was less, postoperative exhaust time （3（2, 4） days） was shorter, time of beginning to eat （5 （4, 6） days） was shorter and the rate of recurrence and metastasis （2.0%） was lower in CME group than those in traditional group （（209. 1±28.3） min, （118, 5±18.6） mL, （4（2, 6） days）, （5（4, 7） days）, 10. 3%） （P〈0.05）. There was no significant difference in the incidence of postoperative complications between CME group （14. 1%） and traditional group （17. 2%） （P〉0.05）. Conclusion CME plus central vessel ligation can increase the number of dissected lymph nodes, shorten the operation lasting time, reduce the intraoperative blood loss, improve the recovery after operation, reduce the recurrence and metastasis and raise the survival rate without increasing the complications.