腹腔镜SMA与SMV左侧为界D3根治术治疗右半肠癌的临床价值比较

Comparison of clinical value of laparoscopic SMA and left-sided SMV D3 radical resection for right hemi-bowel cancer

目的比较腹腔镜肠系膜上动脉(SMA)与肠系膜上静脉(SMV)左侧为界D3根治术治疗右半肠癌的临床价值。方法回顾性分析2017年8月至2019年11月接受手术治疗的83例右半肠癌患者病例资料,将SMA左侧作为术中淋巴结清扫内侧界线的40例患者纳入SMA组,将SMV左侧作为术中淋巴结清扫内侧界线的43例患者纳入SMV组。采用SPSS 25.0软件包处理数据,手术相关指标、淋巴清除情况等计量资料以(x±s)描述,行独立t检验;并发症等计数资料行χ^2检验,P<0.05为差异有统计学意义。结果SMA组术中出血量、术后肛门排气时间、住院时间与SMV组相比,差异无统计学意义(P>0.05);SMA组手术时间、术后引流量、术后引流放置时间、平均阳性淋巴结数量、平均淋巴结清扫总数均比SMV组长/多,差异有统计学意义(P<0.05);SMA组术后并发症总发生率比SMV组高(42.5%vs.20.9%),差异有统计学意义(P<0.05)。结论相较于以SMV左侧为界,腹腔镜SMA左侧为界右半肠癌D3根治术可对病灶进行更加彻底的清扫,但术后并发症较多,临床选择需谨慎。

Objective To compare the clinical value of laparoscopic SMA with left-sided radical resection of SMV in the treatment of right hemi-intestinal cancer.Methods A retrospective analysis of 83 cases of right half bowel cancer patients undergoing surgery from August 2017 to November 2019.40 patients with left side of SMA as medial boundary of intraoperative lymph node dissection were included in the SMA group(40 patients).43 patients with the left side of SMV as the medial line of lymph node dissection during the operation were included in the SMV group(43 cases).SPSS 25.0 software package was used to proofread the whole group of data,surgical related indicators,lymphatic clearance and other measurement data were described by (x±s),and independent t tests were performed;counting data such as complications were describedχ^2 test was performed,P<0.05 was statistically significant.Results Compared with the SMV group,operative blood loss,postoperative anal exhaust time,and length of hospital stay in the SMA group were not significantly different from those in the SMV group(P>0.05).The operative time,the drainage volume,drainage placement time,average number of positive lymph nodes and average total number of lymph node dissections in SMA group were longer or more than those in SMV group,and the difference was statistically significant(P<0.05).The total incidence of postoperative complications in SMA group was higher than that in SMV group(42.5%vs.20.9%),and the difference was statistically significant(P<0.05).Conclusions Compared with the left side of SMV,D3 radical resection of right hemi-intestinal cancer with the left side of laparoscopic SMA as the boundary can perform more thorough clearance of the lesion,but there are more postoperative complications,so the clinical selection needs to be careful.