中尾联合入路腹腔镜下全肠系膜切除术治疗右半结肠癌的疗效评价

Efficacy evaluation of laparoscopic complete mesocolic excision by the middle-tail combined approach for treatment of right colon cancer

目的探讨中尾联合入路腹腔镜D 3根治术联合全肠系膜切除术(CME)治疗右半结肠癌的疗效及对预后的影响。方法纳入2015年4月至2017年1月我院收治的右半结肠癌患者102例,按照随机数字表法分为观察组和对照组,每组51例。观察组患者采用中尾联合入路腹腔镜D 3根治术联合CME治疗,对照组患者采用中央入路腹腔镜D 3根治术联合CME治疗。比较2组患者围术期指标、病理检查及术后并发症情况;随访3年,比较2组患者预后情况。结果观察组患者手术时间、术中出血量少于对照组,差异有统计学意义(P<0.05);2组患者肿瘤切缘阳性率、肿瘤直径、淋巴结清扫数目、阳性淋巴结比例、肿瘤分化程度、病理分期、术后住院时间等比较,差异无统计学意义(P>0.05);2组患者术后并发症发生率比较差异无统计学意义(P>0.05);随访3年,2组患者无进展生存风险比较差异无统计学意义(P>0.05)。结论中尾联合入路腹腔镜D 3根治术联合CME具有并发症少、出血量少、手术时间短的优点,远期预后与中央入路腹腔镜D 3根治术联合全肠系膜切除术相当。

Objective To investigate the efficacy and prognosis of laparoscopic D 3 radical resection combined with complete mesocolic excision(CME)by the middle-tail combined approach for treatment of right colon cancer.Methods The 102 patients with right colon cancer who were admitted into our hospital from April 2015 to January 2017 were divided into the observation group and the control group according to the method of random number table,with 51 patients in each group.Patients of the observation group were treated with laparoscopic D 3 radical resection combined with CME by the middle-tail combined approach,while patients of the control group were treated with laparoscopic D 3 radical resection combined with CME by the central approach.The perioperative indexes,pathological examination and postoperative complications were compared between the two groups.Patients were followed up for 3 years to compare the prognosis of the two groups.Results The operative time and intraoperative blood loss in the observation group were less than those in the control group,with statistically significant differences(P<0.05).There was no statistically significant difference in tumor margin positive rate,tumor diameter,number of lymph node dissection,proportion of positive lymph node,degree of tumor differentiation,pathological stage and postoperative hospital stay between the two groups(P>0.05).There was no significant difference in the incidence of postoperative complications between the two groups(P>0.05).During the follow-up of 3 years,the difference in progression-free survival between the two groups was not statistically significant(P>0.05).Conclusion Laparoscopic D 3 radical resection combined with CME by the middle-tail combined approach has the advantages of less complication,less bleeding and shorter operation time,and its long-term prognosis is equivalent to laparoscopic D 3 radical resection combined with CME by the central approach.