老年Ⅲ期右半结肠癌经腹腔镜全结肠系膜切除治疗的临床效果及预后分析

The clinical outcomes and prognostic analysis of elderly patients with stage Ⅲ right colon cancer undergo laparoscopic complete mesocolon

目的探讨腹腔镜下完整结肠系膜切除术(CME)治疗老年Ⅲ期右半结肠癌的临床效果及预后。方法收集兰州大学第一医院2010-2015年期间280例老年(≥60岁)Ⅲ期右半结肠癌患者的临床资料,其中160例患者接受腹腔镜下CME治疗(称为观察组),120例患者接受传统开腹右半结肠癌根治术(称为对照组)。对比2组患者的平均手术时间、术中出血量、术后肛门首次排气时间、淋巴结清扫数目、阳性淋巴结数目、住院时间及术后并发症情况;分析2组术后局部复发率、远处转移率、3年累积生存率、无瘤生存率及术后复发相关危险因素。结果观察组患者手术时间、淋巴结清扫数目、阳性淋巴结数目以及术后远处转移率与对照组比较差异无统计学意义(P>0.05);观察组患者术中出血量、术后肛门首次排气时间、住院时间和术后复发率少于或短于或低于对照组,其差异均有统计学意义(P<0.05);观察组患者术后3年累计生存率高于对照组(log-rank χ^2=11.865,P=0.001),观察组患者术后3年无瘤生存率高于对照组(log-rank χ^2=7.567,P=0.006);运用logistic回归分析2组患者术后复发的病例发现,肿瘤的分化程度、是否有脉管浸润及淋巴结转移是术后肿瘤复发的相关独立危险因素。结论老年Ⅲ期右半结肠癌经腹腔镜CME治疗效果好,手术安全、可行,可有效延长患者生存时间。

Objective To investigate the clinical effect and prognosis of laparoscopic complete mesocolic resection(CME) in the treatment of elderly patients with stage Ⅲ right colon cancer. Methods Clinical data of 280 elderly patients(aged 60 years or older) who underwent stage Ⅲ right hemicolectomy in the First Hospital of Lanzhou University from 2010 to 2015 were collected. Among them, 160 patients underwent laparoscopic CME treatment were set as the observation group, and 120 patients underwent conventional laparotomy were set as the control group. The mean operative time, intraoperative blood loss, postoperative first anal exhaust time, number of lymph nodes dissection, number of positive lymph nodes, length of hospital stay and postoperative complications were compared between the two groups.The postoperative local recurrence rate, distant metastasis rate, 3-year cumulative survival rate and postoperative recurrence risk factors were analyzed. Results There were no statistically significant differences between the observation group and the control group in operative time, number of lymph node dissection, number of positive lymph nodes and postoperative distant metastasis rate(P>0.05). The amount of intraoperative blood loss, postoperative anal first exhaust time, days of hospitalization, and postoperative recurrence rate in the observation group were less or shorter or lower than those in the control group, with statistically significant differences(P<0.05). The 3-year survival rate in the observation group was higher than that in the control group(log-rank χ^2 =11.865, P=0.001), and the disease free survival in the observation group was also higher than that in the control group(log-rank χ^2=7.567, P=0.006). Logistic regression was used to analyze the cases of postoperative recurrence in the two groups, and it was found that the degree of tumor differentiation, vascular invasion and lymph node metastasis were independent risk factors for postoperative tumor recurrence. Conclusion Laparoscopic CME in the treatment of elderly patients with stage Ⅲ right colon cancer is effective, it is safe and feasible, which can effectively prolong the survival time of patients.