不同内侧界右半结肠癌D3淋巴结清扫前瞻性对比研究

D3 lymphadenectomy in right colon cancer with different medial boundaries:A prospective comparative study

目的对比分析不同内侧界右半结肠癌D3淋巴结清扫的临床效果。方法选取2018年1月至2020年12月于池州市人民医院行腹腔镜右半结肠癌D3淋巴结清扫的56例右半结肠癌患者为研究对象,采用随机数字表法分为两组,各28例,分别以肠系膜上动脉左侧(SMA组)和肠系膜上静脉左侧(SMV组)为内侧界进行腹腔镜右半结肠癌D3淋巴结清扫。比较两组围手术期相关指标、术后并发症及术后生存情况。结果SMA组淋巴结清扫总数和阳性淋巴结数目较SMV组显著增多(P<0.05),两组手术时间、术中出血量及术后引流量、排气时间、住院时间、术后总并发症发生率比较,差异均无统计学意义。术后随访35(18~54)个月,SMA组累积无病生存率(82.1%vs71.4%)及累积总生存率(89.3%vs 78.6%)略高于SMV组,但差异无统计学意义(χ^(2)=0.995、1.402,P=0.319、0.236)。结论以SMV左侧与SMA左侧为内侧界的腹腔镜右半结肠癌D3淋巴结清扫均是安全可行的,在保证肿瘤根治性切除的基础上,以SMA左侧为内侧界清扫淋巴结更彻底,提高了肿瘤根治程度且未显著增加手术风险,有利于改善患者预后。

Objective To compare and analyze the clinical effects of D3 lymphadenectomy in right colon cancer with different medial boundaries.Methods From January 2018 to December 2020,56patients with right colon cancer undergoing laparoscopic D3 lymphadenectomy in the People’s Hospital of Chizhou were selected as the research objects.The patients were randomly divided into two groups,with 28 patients in each group.The left side of the superior mesenteric artery(SMA group)or the left side of the superior mesenteric vein(SMV group)were used as the medial boundary for laparoscopic D3lymphadenectomy of right colon cancer.The perioperative related indexes,postoperative complications and postoperative survival were compared between the two groups.Results The total number of lymphadenectomy and positive lymph nodes in SMA group were significantly higher than those in SMV group(P<0.05).There were no significant differences between the two groups in terms of operation time,intraoperative bleeding volume,postoperative drainage volume,exhaust time,hospital stay,and total incidence of postoperative complications.The cumulative disease-free survival rate(82.1%vs 71.4%)and cumulative overall survival rate(89.3%vs 78.6%)in SMA group were slightly higher than those in SMV group,but the differences were not statistically significant(χ^(2)=0.995,1.402;P=0.319,0.236).Conclusions Laparoscopic D3 lymphadenectomy for right colon cancer with the left side of SMV or the left side of SMA as the medial boundary is safe and feasible.On the basis of ensuring the radical treatment of the tumor,the left side of SMA as the medial boundary can be used to remove the lymph node more thoroughly,improve the degree of radical treatment of the tumor without significantly increasing the risk of surgery,and is conducive to improving the prognosis of patients.