Ⅲ期右半结肠癌行腹腔镜完整结肠系膜切除术与D_(3)根治术的远期疗效对比

Long-term effect comparison of laparoscopic complete mesocolic excision and D_(3) radical resection for stage Ⅲright colon cancer

目的:比较Ⅲ期右半结肠癌患者行腹腔镜完整结肠系膜切除术(CME)与D_(3)根治术的远期疗效。方法:回顾性分析2014年1月—2015年10月收治的102例Ⅲ期右半结肠癌患者的临床资料,其中CME手术50例,D_(3)根治手术52例。比较两组手术指标(手术时间、出血量、输血量、淋巴结清除数及结肠系膜根部淋巴结转移率、术后排气排便时间、并发症发生率、死亡率、住院天数)及两组1、3、5年生存率。结果:CME组淋巴结清除数及结肠系膜根部淋巴结转移率明显优于D_(3)组(P<0.05),而两组1、3、5年生存率差异无统计学意义(P>0.05)。结论:腹腔镜下CME和D_(3)根治术治疗Ⅲ期右半结肠癌的远期疗效相近。下一步笔者将对CME+D_(3)手术进一步研究,以期成为Ⅲ期右半结肠癌手术新的研究方向。

Objective: To compare the long-term efficacy of laparoscopic complete mesocolic excision(CME) and D_(3) radical resection for stage Ⅲ right colon cancer. Methods: The clinical data of 102 patients with stage Ⅲ right colon cancer treated in our department from January 2014 to October2015 were retrospectively analyzed, including 50 cases underwent laparoscopic CME operation and 52 cases underwent laparoscopic D_(3) radical operation. The operation indexes(average operation time, bleeding volume, blood transfusion volume, number of lymph node dissection, lymph node metastasis rate of mesocolon root, exhaust and defecation time, incidence of complications, mortality,hospitalization days) and 1,3,5-year survival rates of the two groups were compared. Results:The results showed that the number of lymph node dissection and the rate of lymph node metastasis in CME group were significantly better than the D_(3) group(P<0.05), but the 1,3,5-year survival rates of the two groups had no significant difference(P>0.05). Conclusion: The long-term effects of laparoscopic CME and D_(3) radical resection are similar. In the next step, the author will further research on CME plus D_(3) operation, hoping to become a new research direction for stage Ⅲ right colon cancer surgery.