腹腔镜下D3清扫联合CEM治疗右半结肠癌的效果分析

Laparoscopic CME and D3 lymph node dissection in the treatment of right hemicolon cancer

目的探讨腹腔镜下D3淋巴结清扫联合完整结肠系膜切除术(CEM)治疗右半结肠癌的临床效果。方法选取2011年1月至2016年1月实施右半结肠癌根治手术的210例患者进行回顾性分析,根据手术方法分为腹腔镜组103例、开腹组107例,两组患者均实施D3清扫+CEM手术,数据分析采用SPSS 16.0进行处理,手术相关指标等计量资料采用均数±标准差(x珋±s)进行描述,t检验;术后并发症率组间比较采用χ2检验;P值<0.05表示差异具有统计学意义。结果腹腔镜组患者的手术时间长于开腹组(P<0.05),腹腔镜组的出血量、切口长度、肛门排气时间、镇痛剂使用率、术后导尿管留置时间、住院时间均低于开腹组(P<0.05);两组患者的切除标本长度、清扫淋巴结数目、阳性淋巴结数目差异无统计学意义(P>0.05);腹腔镜组患者发生手术并发症率是13.6%(14/103)低于开腹组的29.0%(31/107)(χ2=7.372,P<0.05)。结论腹腔镜下D3淋巴结清扫联合CEM治疗右半结肠癌手术安全性高,术后患者恢复较快。

Objective To investigate the effect of laparoscopic complete mesocolic excision（CME）and D3 lymph node dissection in the treatment of right hemicolon cancer. Methods From January 2011 to January 2016,clinical data of 210 patients with right hemicolon cancer who received radical surgery were retrospectively analyzed,including 103 cases in laparoscopic group and 107 cases in laparotomy group. All of 210 patients underwent D3 ＋ CME operation. Statistical analysis were performed by using SPSS 16. 0software. Measurement data such as surgery related index were expressed as mean ± standard deviation（x^-1± s）,and were examined by using t test. Count data,such as postoperative complication rate,were expressed as %,and were examined by using χ^2test. A P value 0. 05 was considered as statistically significant difference. Results The operation time in laparoscopic group was more than that in laparotomy group（P〈0. 05）. Compared with laparotomy group,less blood loss,shorter incision,earlier anal exhaust time,decreased analgesic rate,shorter postoperative indwelling catheter time and hospitalization time could be achieved in laparoscopic group（P〈0. 05）. There were no significant difference between 2 groups in terms of specimen length,the number of lymph nodes and the number of positive lymph nodes（P〈0. 05）.Complication rate of 13. 6%（14/103） in the laparoscopic group was significantly lower than 29. 0%（31/107） in the laparotomy group（χ^2= 7. 372,P〈0. 05）. Conclusion Laparoscopic D3 lymphadenectomy combined with CME in the treatment of right hemicolon cancer is safe with quicker postoperative recovery.