完整结肠系膜切除治疗结肠癌的临床疗效及安全性分析

Analysis of clinical efficacy and safety of complete mesocolon resection in the treatment of colon cancer

目的分析完整结肠系膜切除(CME)治疗结肠癌的临床效果与安全性。方法整理本院收治的42例结肠癌患者(2018年1月~2022年12月)信息,在随机数字表下分为对照组(21例,传统根治术治疗)和观察组(21例,CME治疗);比较两组淋巴结清除情况、围术期指标、并发症及肠道菌群数量。结果观察组术中平均淋巴结清除数量(25.46±2.13)枚、阳性转移淋巴结清除数量(18.33±1.12)枚及左半结肠淋巴结清除数量(8.17±1.62)枚、右半结肠淋巴结清除数量(8.62±1.42)枚均较对照组的(17.22±2.31)、(11.45±1.06)、(6.92±1.33)、(5.67±1.05)枚更多(P<0.05)。两组手术时间对比无差异(P>0.05);观察组术中出血量(121.26±15.33)ml较对照组的(172.33±17.26)ml更少,术后拔管时间(8.10±1.24)d、肛门排气时间(32.12±5.64)h、排便时间(3.46±0.57)d、经口进食时间(3.26±0.90)d、住院时间(9.12±1.32)d均较对照组的(12.11±2.23)d、(46.25±7.12)h、(4.11±0.69)d、(4.11±1.12)d、(12.33±1.35)d更短(P<0.05)。观察组并发症发生率为4.76%,低于对照组的19.05%,但无差异性(P>0.05)。术后3 d,观察组双歧杆菌数量(7.02±1.20)cfu/ml、乳酸杆菌数量(6.89±1.02)cfu/ml、屎肠球菌数量(5.72±0.70)cfu/ml均多于对照组的(6.23±0.91)、(6.23±0.72)、(4.87±0.42)cfu/ml,大肠杆菌数量(8.02±1.03)cfu/ml少于对照组的(9.22±1.20)cfu/ml(P<0.05)。结论完整结肠系膜切除治疗结肠癌效果显著,可提升淋巴结清除数量,减少并发症,加快患者术后恢复进程,维持其肠道菌群稳定性。

Objective To analyze the clinical effect and safety of complete mesocolon resection in the treatment of colon cancer.Methods Data of 42 patients with colon cancer admitted to our hospital(January 2018 to December 2022)were collected and divided into the control group(21 patients,treated with traditional radical surgery)and the observation group(21 patients,treated with CME)under the random number table;Lymph node clearance,perioperative indicators,complications and intestinal flora were compared between the two groups.Results The average number of lymph nodes dissection in the observation group was(25.46±2.13)nodes,the number of dissection of positive metastatic lymph nodes was(18.33±1.12)nodes,the number of lymph nodes dissection in the left half colon was(8.17±1.62)nodes and the number of lymph nodes dissection in the right half colon was(8.62±1.42)nodes,which were higher than those of(17.22±2.31),(11.45±1.06),(6.92±1.33)and(5.67±1.05)nodes in the control group(P<0.05).There was no statistically significant in operative time between the two groups(P>0.05).The intraoperative blood loss of(121.26±15.33)ml in the observation group was less than that of(172.33±17.26)ml in the control group;the postoperative extubation time in the observation group was(8.10±1.24)d,the anal exhaust time was(32.12±5.64)h,the defecation time was(3.46±0.57)d,the oral feeding time was(3.26±0.90)d and the hospitalization time was(9.12±1.32)d,which were all shorter than those of(12.11±2.23)d,(46.25±7.12)h,(4.11±0.69)d,(4.11±1.12)d and(12.33±1.35)d in the control group(P<0.05).There was no significant difference in the incidence of complications between the observation group and thecontrol group(4.76%vs19.04%)(P>0.05).At 3 d after surgery,the numbers of Bifidobacterium,Lactobacillus and Enterococcus faecium were(7.02±1.20),(6.89±1.02)and(5.72±0.70)cfu/ml in the observation group,which were higher than those of(6.23±0.91),(6.23±0.72)and(4.87±0.42)cfu/ml in the control group;the number of Escherichia coli of(8.02±1.03)cfu/ml in the observation group was lower than that of(9.22±1.20)cfu/ml in the control group(P<0.05).Conclusion Complete mesocolon resection has a significant effect on colon cancer patients,which can increase the number of lymph nodes dissection,reduce complications,speed up the recovery process of patients after surgery,maintain the stability of their intestinal flora.