结肠癌急诊全结肠系膜切除术的临床疗效

Clinical efficacy of complete mesocolic excision in the emergency surgery for patients with colon cancer

目的:探讨全结肠系膜切除术(complete mesocolic excision,CME)与传统根治术在结肠癌急诊手术中的短期临床效果与安全性。方法:回顾性分析2011年1月至2017年12月于民航总医院住院行结肠癌急诊手术53例患者的临床资料。根据入组时间和手术方式,自2014年5月起入院的患者纳入CME组(25例),之前的患者纳入传统手术组(28例)。所有患者术中均行肿瘤远近端肠管灌洗。分析不同手术方式短期临床效果的异同。结果:CME组和传统手术组的淋巴结清扫数目分别为(31.7±2.9)枚和(19.5±4.2)枚,差异具有统计学意义(P<0.05)。两组患者的手术时间分别为(176.0±42.3)min和(157.5±33.5)min,手术出血量分别为(148.7±74.0)mL和(128.9±50.0)mL,住院时间分别为(27.2±10.4)d和(23.1±6.3)d,首次肛门排气时间分别为(75.0±3.3)h和(75.3±3.7)h,差异均无统计学意义(P>0.05)。两组患者在病理分期、术后并发症率和死亡率等方面差异均无统计学意义(P>0.05)。结论:CME与传统根治手术短期临床效果接近,CME淋巴结清扫更为彻底,可安全应用于结肠癌急诊患者中。

Objective: To compare the short-term clinical efficacy and feasibilities between complete mesocolic excision(CME) and traditional radical resection in emergency surgery for patients with colon cancer. Methods: Clinical data for 53 cases of colon cancer treated by emergency surgery between January 2011 and December 2017 in Civil Aviation General Hospital were analyzed. On the basis of the entry time and various operation procedures, the 53 patients were assigned into two groups: the CME group(n=25) that underwent CME in May 2014 or later and the traditional operative group(n=28) that underwent traditional radical resection before May2014. Distal and proximal colonic and intestinal lavage were performed in all patients. The short-term clinical effects of these different methods were analyzed. Results: The number of excised lymph nodes in the CME group and traditional group was 31.7±2.9 and 19.5±4.2, respectively, and the difference between the groups was statistically significant(P<0.05). The operation time of the two groups was(176.0±42.3) min and(157.5±33.5) min and the blood loss was(148.7±74.0) mL and(128.9±50.0) m L, respectively. The length of hospital stay of the two groups was(27.2±10.4) days and(23.1±6.3) days and the first flatus time was(75.0±3.3) h and(75.3±3.7) h, respectively. The difference between the two groups in these parameters was not statistically significant(P>0.05). In addition, there was no significant differences in pathological staging, postoperative complications, or mortality between the CME group and traditional operative group(P>0.05). Conclusions: The short-term clinical efficacy of CME is similar to that of traditional radical cancer surgery with the advantage of more extensive lymph node dissection. CME can be used safely in patients with colon cancer undergoing an emergency operation.