横结肠切除与扩大结肠切除治疗横结肠癌疗效比较

Comparison of transverse colectomy and extended colectomy in the treatment of transverse colon cancer

目的比较横结肠切除与扩大结肠切除治疗横结肠癌的疗效差异,寻找合适的手术方式,为临床治疗提供参考。方法收集于2006年1月至2019年12月在广东省人民医院胃肠外科接受手术治疗的横结肠癌患者的临床病理资料。分析两组术式生存及临床指标差异等。结果共纳入366例患者,其中横结肠切除58例,扩大结肠切除308例。横结肠切除组与扩大结肠切除组的5年总生存率、5年无病生存率差异无统计学意义(均P>0.05);在TNMⅠ期、Ⅱ期、Ⅲ期患者中,横结肠切除组与扩大结肠切除组的5年总生存率差异无统计学意义(均P>0.05)。横结肠切除组术中出血量少于扩大结肠切除组[(55.0±29.0)mL、(96.9±28.3)mL]、横结肠切除组清扫淋巴结数少于扩大结肠切除组[(19.5±8.4)枚、(23.1±11.4)枚],差异均有统计学意义(均P<0.05)。两组的手术时间、术后住院时间、术后出现吻合口漏、腹腔感染、伤口感染、肠梗阻、复发转移差异无统计学意义(均P>0.05)。单因素分析结果显示,术后T分期、术后N分期、脉管癌栓侵犯、术后化疗、手术入路、肿瘤大体分型、肿瘤分化程度是影响患者预后的危险因素(均P<0.05)。将上述单因素危险因素纳入多因素分析显示,术后T分期、术后N分期、脉管癌栓侵犯、术后化疗、手术入路、肿瘤大体分型、肿瘤分化程度均是影响患者生存预后的独立危险因素(均P<0.05)。结论横结肠切除与扩大结肠切除治疗横结肠癌患者远期预后相当,横结肠切除并没有增加术后出现并发症的风险,横结肠切除可安全用于横结肠癌患者。

Objective To compare the curative effect of transverse colon resection and extended colon resection in the treatment of transverse colon cancer,and to find a suitable surgical method to provide reference for clinical treatment.Methods The clinicopathological data of patients with transverse colon cancer who received surgical treatment in the gastrointestinal surgery department of Guangdong Provincial People's Hospital from January 2006 to December 2019 were collected.Analyze the differences in surgical survival and clinical indicators between the two groups.Results A total of 366 patients were included,including 58 cases of transverse colon resection and 308 cases of extended colon resection.There was no significant difference in 5-year overall survival rate and 5-year disease-free survival rate between the transverse colon resection group and the extended colon resection group(all P>0.05).There was no significant difference in the 5-year overall survival rate between the transverse colon resection group and the extended colon resection group in patients with TNM stage Ⅰ,Ⅱ and Ⅲ(all P>0.05).The amount of intraoperative bleeding in the transverse colon resection group was less than that in the extended colon resection group[(55.0±29.0)mL,(96.9±28.3)mL],and the number of lymph nodes cleared in the transverse colon resection group was less than that in the extended colon resection group[(19.5±8.4),(23.1±11.4)],which were statistically significant(all P<0.05).The results of univariate analysis showed that postoperative T stage,postoperative N stage,vascular cancer thrombus invasion,postoperative chemotherapy,surgical approach,tumor gross classification,and tumor differentiation were risk factors affecting patient prognosis(all P<0.05).The inclusion of single factor risk factors in multivariate analysis showed that postoperative T stage,postoperative N stage,vascular tumor thrombus invasion,postoperative chemotherapy,surgical approach,tumor gross classification,and tumor differentiation were all independent risk factors affecting patient survival and prognosis(all P<0.05).Conclusion Transverse colectomy has the same long-term prognosis as extended colectomy in the treatment of patients with transverse colon cancer.Transverse colectomy does not increase the risk of postoperative complications.Transverse colectomy can be safely used in patients with transverse colon cancer.