腹腔镜辅助右半结肠癌扩大根治术清扫SMA表面淋巴结的安全性研究

A study on the safety of laparoscopic-assisted extended radical resection for right colon cancer with dissection of lymph nodes on the surface of superior mesenteric artery

目的探讨腹腔镜辅助右半结肠癌扩大根治术清扫肠系膜上动脉表面淋巴结的安全性。方法纳入2019年1月至2023年8月期间在海军军医大学第一附属医院,由同一位主刀医师进行腹腔镜辅助右半结肠癌扩大根治术的167例患者作为研究对象。基于倾向性评分匹配,按照1∶4的比例,分别将以肠系膜上动脉左侧和肠系膜上静脉左侧为淋巴结清扫内侧界的患者分为肠系膜上动脉组(n=30)和肠系膜上静脉组(n=104)。在匹配完成后,比较两组术中情况、术后情况和术后病理情况。结果两组术中出血量、术后腹部引流液总量、术后住院时间、术后首次排粪时间、术后并发症发生情况、肿瘤位置、肿瘤大小、分化程度、T分期、N分期比较差异无统计学意义(P>0.05)。肠系膜上动脉组清扫淋巴结总数、阳性淋巴结总数、清扫第六组淋巴结患者比例高于肠系膜上静脉组(P<0.05)。其中有3例患者第六组淋巴结阳性,SMA组中3例患者SMA表面淋巴结阳性。结论腹腔镜辅助右半结肠癌扩大根治术中,以肠系膜上动脉左侧为淋巴结清扫内侧界可以清扫更多的淋巴结,并可以清除肠系膜上动脉表面潜在转移的淋巴结,同时并未显著增加术中出血量和术后并发症发生率。

Objectives To investigate the safety of laparoscopic-assisted extended radical resection for right colon cancer with dissection of lymph nodes on the surface of the superior mesenteric artery(SMA).Methods A total of 167 patients who underwent laparoscopic-assisted extended radical resection for right colon cancer performed by the same lead surgeon in the First Affiliated Hospital of Naval Medical University from January 2019 to August 2023 were included in the study.Based on propensity score matching,patients were divided into the SMA group(n=30)and the superior mesenteric vein(SMV)group(n=104)at a ratio of 1:4,with the left side of the SMA and the left side of the SMV as the medial boundary of lymph node dissection.After matching,intraoperative conditions,postoperative conditions,and postoperative pathology indicators were compared between the two groups.Results There were no significant differences in intraoperative blood loss,total amount of postoperative abdominal drainage fluid,postoperative hospital stay,first postoperative defecation time,postoperative complications,tumor location,tumor size,degree of differentiation,T stage,and N stage between the two groups(P>0.05).The total number of dissected lymph nodes,the total number of positive lymph nodes,the proportion of patients with dissected lymph nodes in group 6 were higher in the SMA group than in the SMV group(P<0.05).There were 3 patients with positive lymph nodes in group 6.Three patients in the SMA group showed positive lymph nodes on the surface of the SMA.Conclusion In laparoscopic-assisted extended radical resection for right colon cancer,taking the left side of SMA as the medial boundary of lymph node dissection can harvest more lymph nodes and eliminate potentially metastatic lymph nodes on the surface of SMA,without significantly increasing intraoperative blood loss and the incidence of postoperative complications.