腹腔镜下全结肠系膜切除治疗结肠癌的疗效分析

Curative Effect Analysis on Complete Mesocolic Excision Curing Colon Cancer Under Laparoscope

目的比较腹腔镜下全结肠系膜切除(CME)与传统开腹全结肠系膜切除(CME)治疗结肠癌的短期疗效及分析行腹腔镜CME手术时常规暴露肠系膜上、下动脉根部、腔静脉与腹主动脉的意义。方法回顾性分析本治疗组2013年12月～2016年12月行腹腔镜CME治疗的120例结肠癌患者及2010年5月～2013年5月行开腹CME治疗的116例结肠癌患者的临床资料,比较两组患者的手术时间、出血量、淋巴结清扫数目、术后并发症、进食时间及1年后肿瘤复发转移情况;同时分析2013年12月～2016年12月行腹腔镜CME组手术中常规暴露肠系膜上、下动脉根部、腔静脉与腹主动脉(64例)与仅高位结扎肠系膜上、下动脉而未暴露腔静脉与腹主动脉的临床资料(56例),比较两组患者的手术时间、出血量、淋巴结清扫数目、术后并发症、进食时间及1年后肿瘤复发转移情况。结果腹腔镜下CME组在术后并发症、进食时间方面具有明显优势(P<0.05);常规暴露肠系膜上、下动脉根部、腔静脉与腹主动脉组的手术时间、出血量、术后并发症、进食时间及1年后肿瘤复发转移情况与对照组差异均无统计学意义,但淋巴结清扫数目明显多于对照组(P<0.05)。结论腹腔镜下结肠全系膜切除(CME)安全可行,短期疗效满意;腹腔镜CME术中常规暴露肠系膜上、下动脉根部、腔静脉与腹主动脉对结肠癌术后短期疗效无明显意义,但对结肠癌的根治性手术有临床意义。

Objective Comparing the short-term curative effects pf CME under iaparoscope and traditional CME and analyzing the meaning of exploring mesentery up and lower artery root, venae cavae and adbominal aorta under laparoscope CME operation. Methods Retrospecting the clinic material of laparscope CME cure 120 colon cancer patients from December 2013 to December 2016 and open CME cure 116 colon cancer patients from May 2010 to May 2013. It contrasts the operation time, cadaverine quantity of bleeding, neck dissection clear number, complication, eating time and tumor recurrence and metastasis after 1 year of two groups ＇ patients; at the same time, it also analyzes 120 laparscope CME operation randomly group from December 2013 to December 2016 regular clinic materials of exploring mesentery up and lower artery root, venae cavae and adbominal aorta （64 cases） and only high ligationmesentery up and lower artery root, but non-exploringvenae cavae and adbominal aorta （56 cases） which contrast the operation time, cadaverine quantity of bleeding, neck dissection clear number, complication,eating time of two groups＇ patients and and tumor recurrence and metastasis after 1 year. Results Laparscope CME operation＇ s complication, eating time show-obvious advantages （P〈0.05）; regular exploring mesentery up and lower artery root, venae cavae and adbominal aorta＇s operation time, cadaverine quantity of bleeding, neck dissection clear number, complication, eating time and tumor recurrence and metastasis after 1 year show-no statistic difference with contrast group, but the number of lymph node dissection was significantly higher than that of the control group （P〈0.05）. Conclusion Laparoscope CME is safe and reliable and contains a satisfied short-term curative effect; Laparoscopic CMEregular exploring mesentery up and lower artery root, venae cavae and adbominal aorta show-no obvious meaning of short-term effectin colon cancer, but it have clinical significance of radical surgery for colon cancer.