以肠系膜上动脉左右侧为淋巴结清扫内侧界的腹腔镜右半结肠癌根治术的对比研究

A comparative study on lymph node dissections bounded by the right vs.left sides of superior mesenteri artery in laparoscopic radical resection for right colon cancer

目的研究分别以肠系膜上动脉左、右侧为淋巴结清扫内侧界的腹腔镜右半结肠癌根治术的手术效果。方法回顾性分析102例进展期右半结肠癌患者的临床资料,根据淋巴结清扫范围不同分为研究组(48例)和对照组(54例)。两组患者均行腹腔镜下右半结肠癌根治术,研究组淋巴结清扫内侧界为肠系膜上动脉左侧,对照组为肠系膜上动脉右侧,比较两组患者的手术时间、住院时间、术后第1天血清CPR、术后病理清扫淋巴结数目及并发症发生情况。结果研究组手术时间长于对照组[(169±24)min比(138±28)min,t=4.827,P<0.05],差异有统计学意义。两组患者在住院时间[(10.5±1.7)d比(9.7±2.0)d,t=1.172,P>0.05]、血清CRP水平[(110±44)mg/L比(100±39)mg/L,t=1.287,P>0.05]、术后并发症(12例比9例,P>0.05)方面差异均无统计学意义。研究组术后病理清扫淋巴结数目多于对照组[(23.8±8.2)枚比(19.7±6.8)枚,t=2.191,P<0.05],差异有统计学意义,但两组阳性淋巴结数目差异无统计学意义[(2.2±4.9)枚比(1.4±2.8)枚,t=0.863,P>0.05]。结论以肠系膜上动脉左侧为界的腹腔镜右半结肠癌手术可以清扫更多的淋巴结,并且扩大的清扫并未明显增加手术并发症及术后应激反应。

Objective To compare the results of lymph node dissection boundaries along the right or left sides of SMA in laparoscopic radical resection for right colon cancer.Methods One hundred and two patients with advanced right colon cancer were selected for retrospective analysis,the patients were divided into study group(48 cases)and control group(54 cases)according to the extent of lymph node resection.The medial boundary of lymph node dissection in the study group was on the left side of SMA,and the control group was on the right side of SMA.The operation duration,hospital stays,CRP(postoperative day 1),the number of dissected lymph nodes and the complications were compared.Results The operation duration of the study group was longer than that of the control group[(169±24)min vs.(138±28)min,t=4.827,P<0.05],but there was no statistically significant difference in hospital stays[(10.5±1.7)d vs.(9.7±2.0)d,t=1.172,P>0.05],CRP(postoperative day 1)[(110±44)mg/L vs.(100±39)mg/L,t=1.287,P>0.05],incidence of postoperative complication(12 cases vs.9 cases,P>0.05)between the two groups.The number of lymph nodes removed in the study group was more than that in the control group[(23.8±8.2)vs.(19.7±6.8),t=2.191,P<0.05],though the number of positive lymph nodes removed in the two groups was not significantly different[(2.2±4.9)vs.(1.4±2.8),t=0.863,P>0.05].Conclusions Laparoscopic radical resection for right colon cancer along the left sides of SMA removed more lymph nodes without significant increase of the surgical complications.