腹腔镜完整结肠系膜切除术治疗横结肠癌的疗效评价

Efficacy evaluation of laparoscopic complete mesocolic excision for transverse colon cancer

目的探讨横结肠癌患者行腹腔镜全结肠系膜切除术的安全性、可行性及长期肿瘤学疗效。方法回顾性分析2011年1月至2014年1月间在广东省佛山市第一人民医院胃肠外科接受腹腔镜完整结肠系膜切除术的61例横结肠癌患者的临床资料（横结肠癌组），并与同期行腹腔镜完整结肠系膜切除术的155例升结肠癌（升结肠癌组）及230例乙状结肠癌（乙状结肠癌组）患者进行比较，评估3组患者手术指标、术后恢复指标、术后并发症及远期生存情况的差异。结果3组患者基线资料的差异均无统计学意义（均P 〉 0.05）。术中及术后恢复情况，除手术时间横结肠癌组较升结肠癌组和乙状结肠癌组显著延长外[（192.1 ± 58.7）min、（172.2 ± 54.7）min和（169.1 ± 53.6）min]（P 〈 0.05），3组其他指标包括术中出血量[（89.7 ± 63.6）ml、（86.3 ± 66.3）ml和（82.6 ± 61.5）ml]、中转开腹率[3.3%（2/61）、2.6%（4/155）和2.2%（5/230）]、淋巴结数获检数[（13.0 ± 4.7）枚、（14.4 ± 6.5）枚和（13.4 ± 5.6）枚]、术后肛门排气时间[（2.7 ± 1.1）d、（2.6 ± 1.1）d和（2.5 ± 1.0）d]、进食流质时间[（3.0 ± 1.7）d、（2.8 ± 1.5）d和（2.7 ± 1.4）d]、术后并发症发生率[6.6%（14/61）、9.0%（14/155）和11.7%（27/230）]及术后住院时间[（11.6 ± 5.8）d、（10.7 ± 5.8）d和（10.6 ± 5.7）d]的差异均无统计学意义（均P 〉 0.05）。术后436例患者获得随访，中位随访时间36（5~67）月。横结肠癌组、升结肠癌组和乙状结肠癌组术后5年总生存率分别为73.1%、73.7%和74.8%，5年无瘤生存率分别为71.5%、71.1%和72.7%，差异均无统计学意义（均P 〉 0.05）。结论腹腔镜全结肠系膜切除术对于横结肠癌的治疗除手术时间较长外安全可行，并可获得较好的长期肿瘤学效果。

ObjectiveTo investigate the safety, feasibility and long-term outcomes of laparoscopic complete mesocolic excision for the transverse colon cancer.MethodsClinical data of 61 patients who underwent laparoscopic complete mesocolic excision for transverse colon cancer （transverse group） in our department from January 2011 to January 2014 were retrospectively analyzed, which were compared with those of 155 patients undergoing laparoscopic complete mesocolic excision for ascending colon cancer （ascending group） and 230 patients undergoing laparoscopic complete mesocolic excision for sigmoid colon cancer （sigmoid group） . Differences in operative details, postoperative recovery, postoperative complications and long-term survival among 3 groups were evaluated.ResultsNo significant differences in the baseline information were found among 3 groups （all P 〉 0.05） . The average operative time was significantly longer in transverse group as compared to ascending group and sigmoid group[ （192.1 ±58.7） min vs. （172.2 ± 54.7） min and （169.1 ± 53.6） min] （P 〈 0.05） , while the blood loss [ （89.7 ± 63.6） ml, （86.3 ± 66.3） ml, （82.6 ± 61.5） ml], conversion rate [3.3% （2/61） , 2.6% （4/155） , 2.2% （5/230） ], number of harvested lymph node （13.0 ± 4.7, 14.4 ± 6.5, 13.4 ± 5.6） , time to flatus [ （2.7 ± 1.1） d, （2.6 ± 1.1） d, （2.5 ± 1.0） d], time to liquid diet [ （3.0 ± 1.7） d, （2.8 ± 1.5） d, （2.7 ± 1.4） d], incidence of postoperative complication （6.6%, 9.0%, 11.7%） , and hospital stay [ （11.6 ± 5.8） d, （10.7 ± 5.8） d, （10.6 ± 5.7） d] among 3 groups were not significantly different （all P 〉 0.05） . A total of 436 patients received postoperative follow-up of median 36 （5 to 67） months. The overall 5-year survival rate was 73.1%, 73.7% and 74.8%, and the 5-year disease-free survival rate was 71.5%, 71.1% and 72.7% in transverse, ascending and sigmoid colon cancer groups respectively, whose differences were not significant among 3 groups （all P 〉 0.05） .ConclusionLaparoscopic complete mesocolic excision for transverse colon cancer is safe and feasible with slightly longer operation time, and has quite good long-term oncologic efficacy.