腹腔镜下D3根治术与全结肠系膜切除术治疗右半结肠癌的疗效观察

Comparison of laparoscopic D3 radical surgery versus total mesenterectomy on efficacy in patients with right hemicolon carcinoma

目的探讨腹腔镜下D3根治术与全结肠系膜切除术(CME)治疗右半结肠癌的疗效。方法本研究选取2015年5月-2017年8月乐山市某医院收治的156例结肠癌患者为研究对象,其中65例接受腹腔镜D3根治术(D3根治术组),91例接受腹腔镜CME(CME组)。比较2组患者手术时间、肠道排气时间、住院天数、术中出血量、术后引流量、淋巴结清扫数量、术后并发症发生情况及术后随访2年结肠癌复发及转移情况。结果D3根治术组患者的手术时间、肠道排气时间、住院天数均短于CME组,差异均有统计学意义(P<0.05);术中出血量、术后引流量、淋巴结清扫数量均少于CME组,差异均有统计学意义(P<0.05)。D3根治术组患者术后并发症发生率为6.15%,低于CME组患者的6.59%,但差异无统计学意义(P>0.05)。术后随访2年,D3根治术组患者复发及转移发生率为12.30%(Ⅱ期1例肝转移,Ⅲ期2例肝转移、1例肺转移;Ⅱ期2例局部复发,Ⅲ期2例局部复发),高于CME组的5.50%(Ⅲ期2例肝转移;Ⅱ期1例局部复发,Ⅲ期2例局部复发),但差异无统计学意义(P>0.05)。结论腹腔镜下D3根治术治疗右半结肠癌较CME疗效更显著,且安全性高,值得临床推广应用。

Objective To investigate the effect of laparoscopic radical D3 radical surgery and total mesocolonectomy(CME)on right colon cancer.Methods The clinical data of 156 patients with colon cancer admitted to a hospital in Leshan City from May 2015 to August 2017 were retrospectively analyzed,of which 65 patients underwent laparoscopic D3 radical surgery(D3 radical surgery group)and 91 patients underwent laparoscopic CME surgery(CME group).The operation time,intestinal exhaust time,length of hospital stay,intraoperative bleeding volume,postoperative drainage volume,number of lymph node dissection,postoperative complications,and colon cancer recurrence and metastasis were compared between the two groups.Results The operation time,intestinal exhaust time,and length of hospital stay were shorter in the D3 radical surgery group than in the CME group,and the differences were statistically significant(P<0.05).The intraoperative blood loss,postoperative drainage volume,and lymph node dissection were all less than the CME group,the differences were statistically significant(P<0.05).The postoperative complication rate of patients in the D3 radical surgery group was 6.15%,which was lower than 6.59%in CME patients,but the difference was not statistically significant(P>0.05).After 2 years of follow-up,the incidence of recurrence and metastasis in the D3 radical surgery group was 12.30%(1 liver metastasis in stageⅡ,2 liver metastases,and 1 lung metastasis in stageⅢ;2 cases of local recurrence in stageⅡ,and 2 cases of stageⅢLocal recurrence)was higher than 5.50%in the CME group(2 cases of liver metastasis in stageⅢ;1 case of local recurrence in stageⅡ,2 cases of local recurrence in stageⅢ),but the difference was not statistically significant(P>0.05).Conclusion Laparoscopic D3 radical surgery is more effective and safe in treating right colon cancer than CME.It is worthy of clinical application.