术前CT无淋巴结转移的右半结肠癌D_3手术198例报告

D_3 dissection in right colon cancer patients without lymph node metastasis in preoperative study

目的探讨D_3手术在术前CT诊断无淋巴结转移的右半结肠癌根治中的价值。方法回顾性分析本院2006年1月至2014年12月手术切除的结肠癌患者的临床资料。CT诊断淋巴结转移的标准为淋巴结短径/长径>0.8,呈圆形或不规则形或呈融合状,增强扫描后呈不规则强化。右半结肠癌的D_3清扫定义为清除回结肠动脉、右结肠动脉(若存在)、中结肠动脉右支或主干(扩大右半结肠切除)根部的淋巴结。结果 2006年1月至2014年12月共收治结肠癌患者1278例,275例术前诊断为无淋巴结转移的右半结肠癌患者进入研究。275例患者中分别有77例及198例接受D_2及D_3手术,D_3手术组主淋巴结转移率为3.5%(7/198)。全组患者共有15.6%(43/275)出现术后并发症,其中D_2及D_3组并发症发生率分别为13.0%(10/77)及16.7%(33/198),两组比较差异无显著性。Logistic回归分析发现,高龄、急诊手术、开腹手术及肿瘤高T分期是患者发生术后并发症的危险因素(P<0.05)。结论术前诊断无淋巴结转移的右半结肠癌患者,虽然D_3手术不增加术后并发症的风险,但其主淋巴结实际转移率较低,对患者预后的影响仍待进一步研究。

Objective To discuss the necessity of D3 dissection in right colon cancer patients without lymph node metastasis in preoperative CT study. Method Retrospective analyses the clinical data of right colon cancer patients who received surgical therapy in our hospital between Jan 2006 and Dec 2014. The criterion of lymph node metastasis in CT study including short/long axis diameter ratio was greater than 0.8, clusters of different lymph nodes and irregular enhancement after introducing contrast. D3 dissection in right hemicolectomy was defined dissecting the lymph node at root of ileocolic artery, right colic artery （if present） and right branch or trunk of middle colic artery （extended right colectomy）. Result Between Jan 2006 and Dec 2014, there were 1278 colon cancer patients received surgery in our department. Two hundred and seventy-five right colon cancer patients without lymph node metastasis in preoperative CT study were included in our study. D2 and D3 dissection were performed in 77 and 198 patients, respectively with apical lymph node metastasis rate 3.5%（7/198）. Overall complication rate was 15.6%（43/275）. Morbidity in D2 and D3 group was 13.0%（10/77） and 16.7%（33/198）, respectively with no statistical difference. Elderly patients, emergency operation, open surgery and high T stage of tumor were the risk factors for postoperative complications in logistic regression analysis. Conclusion In right colon cancer patients without lymph node metastasis in preoperative study, despite D3 dissection did not increase the complication rate, the apical lymph node metastasis rate was extremely low. The impact of such surgery on prognosis needs further investigated.