腹腔镜下全结肠系膜切除术与传统结肠癌手术的近期疗效比较

Short-term efficacy of laparoscopic complete mesocolic excision versus traditional colon cancer resection in patients with colon cancer

目的探讨结肠癌患者接受腹腔镜全结肠系膜切除术(omplete mesocolic excision,CME)的近期疗效和安全性。方法回顾性分析2012年2月至2016年3月间本院收治的96例结肠癌患者的临床资料,其中52例接受腹腔镜CME手术(CME组),44例行腹腔镜传统结肠癌根治术(对照组),比较两组患者的淋巴结清扫数量、手术时间、术中出血量、术后进食时间及术后并发症。结果 CME组患者淋巴结清扫数量比对照组多(18.38±2.73 vs 16.48±1.72,P<0.01),其中CME组的右半结肠癌患者清扫淋巴结明显多于对照组(19.18±2.73 vs 16.96±1.68,P<0.01),两组中的Ⅲ期患者淋巴结清扫数量差异具有显著性(19.50±2.96 vs 17.09±1.35,P<0.01)。两组患者的手术时间、术中出血量、术后进食时间以及术后住院时间的差异均无显著性(P>0.05)。CME组和对照组在切口脂肪液化、不完全性肠梗阻、下肢深静脉血栓以及肺部感染等术后并发症的发生率差异无显著性(P>0.05)。结论结肠癌患者行腹腔镜CME术是安全的,该术式不会影响患者术后恢复,也不会增加术后并发症发生的风险,同时可以获得更佳的肿瘤根治效果。

Objective To explore the short-term outcomes and safety of laparoscopic complete mesocolic excision（CME） in patients with colon cancer. Method The clinical pathological factors of 96 patients with colon cancer who were in general surgery Xuanwu Hospital from February 2012 to March 2016 were analyzed retrospectivly. These patients were divided into laparoscopic CME surgery groups（n=52） and laparoscopic traditional surgery groups（n=44）. The number of lymph node dissection, operation time, blood loss, postoperative feeding time and postoperative complications were compared between the two groups. Result More number of lymph nodes were removed in the CME group than that in the control group（18.38±2.73 vs 16.48±1.72, P〈0.01）. In patients with right colon cancer, CME group was associated with higher lymph node counts（19.18±2.73 vs 16.96±1.68, P0.01）. In patients with stage Ⅲ cancer,CME group was associated with great harvest of lymph node（19.50±2.96 vs 17.09±1.35, P〈0.01）. There were no differences in operation time, intraoperative blood loss, time to eating and postoperative hospital stay（P〈0.05）. There were some acceptable postoperative complications in each groups,such as pulmonary infection, deep venous thrombosis and incomplete intestinal obstruction, but showed no statistical significances（P〉0.05）. Conclusion Laparoscopic CME procedure is so safe that will not affect postoperative recovery. It also does not increase the risk of postoperative complications.More important, patients can achieve better oncologic clearance effects than the control group.