腹腔镜全结肠系膜切除术治疗老年Ⅲ期结肠癌患者的疗效分析

Effect of laparoscopic complete mesocolic excision for treatment of elder patients with stage Ⅲ colon cancer

目的:探讨腹腔镜全结肠系膜切除术(complete mesocolic excision,CME)治疗老年Ⅲ期结肠癌患者的临床疗效。方法:回顾分析2011年1月至2012年9月99例行腹腔镜结肠癌根治术的Ⅲ期结肠癌老年患者的临床资料,根据患者要求选择手术方式,50例患者行传统腹腔镜结肠癌根治术(对照组),49例行腹腔镜CME(CME组),比较两组患者术中淋巴结清扫效果、术中出血量、手术时间、术后住院时间、术后排气及进食时间、并发症发生率、住院时间及随访3年生存率。结果:对照组清扫淋巴结数量平均(19.8±2.8)枚,明显少于CME组(26.6±3.9)枚,差异有统计学意义(P<0.05);两组患者术中出血量、手术时间、术后排气及进食时间、术后住院时间、并发症发生率差异均无统计学意义(P>0.05),3年生存率CME组显著优于对照组,差异有统计学意义(P<0.05)。结论:腹腔镜CME治疗老年Ⅲ期结肠癌患者,能增加淋巴结清扫的数量,改善患者的生存预后,且不会增加术中风险及术后并发症,术后效果良好。

Objective： To investigate the effect of laparoscopic complete mesocolic excision（ CME） for treatment of elder patients with stage Ⅲ colon cancer. Methods： The clinical data of 99 elderly patients with stage Ⅲ colon cancer who underwent laparoscopic radical resection in 215 Hospital of Shaanxi Nuclear Industry from Jan. 2011 to Sep. 2012 were retrospectively analyzed. According to the surgical approach that the patient selected,50 cases treated with laparoscopic colonic cancer resection were divided into control group and 49 cases treated with laparoscopic CME were in CME group. The lymph node dissected,intraoperative blood loss,operative time,postoperative hospital stay,postoperative exhaust and eating time,complications,hospital stay and 3-year survival rate were compared between the two groups. Results： The number of lymph nodes retrieved in CME group（ 26. 6 ± 3. 9） was significantly more than（ 19. 8 ± 2. 8） in control group（ P〈0. 05）. There were no significant differences in intraoperative blood loss,operation time,postoperative hospital stay,first flatus time,postoperative eating time,postoperative complications（ P〈0. 05）. The survival rate of 3-year in CME group was significantly higher than that of control group（ P〈0. 05）. Conclusions： Laparoscopic CME could increase the number of lymph node dissected in treatment of elderly patients with stage Ⅲ colon cancer,and improve the survival prognosis. It would not increase the risk of surgery or postoperative complications,and the postoperative effect is favorable.