微创全结肠系膜切除治疗结肠癌的临床疗效分析

Efficacy of minimal invasive complete mesocolic excision in patients with colon cancer

目的探讨腹腔镜下微创全结肠系膜切除(CME)对结肠癌患者疗效、生存率及并发症的影响。方法回顾性分析2011年12月至2014年12月于我院治疗的113例结肠癌患者的临床资料,将采取腹腔镜下微创CME治疗的55例患者设为观察组,采取传统开腹手术治疗的58例患者设为对照组。比较2组患者手术及住院相关指标、并发症发生情况,记录2组患者远处转移率以及1年、3年生存率。结果观察组患者术中出血量、住院时间、术后引流量显著低于对照组,2组比较差异具有统计学意义(P <0. 05),2组患者手术时间、首次排气时间、淋巴结清扫数量、尿管拔除时间差异无统计学意义(P> 0. 05);观察组患者切口感染发生率显著低于对照组,差异具有统计学意义(P <0. 05); 2组患者吻合口渗血、切口裂开发生率差异无统计学意义(P> 0. 05);患者随访36～72个月,平均(50. 34±4. 34)个月,2组患者远处转移率、局部复发率、无瘤生存率以及1年、3年生存率差异均无统计学意义(P> 0. 05)。结论腹腔镜下微创CME治疗结肠癌能获得与传统开腹手术相同的淋巴结清扫效果,远处转移及生存率无明显差异,但具有创伤小、恢复时间快等优势,而且能显著降低院内感染率。

Objective To study the effect of minimal invasive complete mesocolic excision( CME) on the efficacy,survival rate and complications in patients with colon cancer. Methods A total of 113 patients with colon cancer treated in our hospital from December 2011 to December 2014 were included in this study as the objects. Medical records of these patients were analyzed retrospectively. The 55 patients treated with minimal invasive CME were set as the observation group,and the other 58 patients treated with traditional open surgery were set as the control group. The surgical and hospital-related parameters and complications were compared between the two groups. The distant metastasis rate and 1-year and 3-year survival rates of the two groups were recorded. Results The intraoperative blood loss,length of hospital stay and postoperative drainage in the observation group were significantly lower than those in the control group( P < 0. 05). The differences of the operative time,first exhaust time,the number of lymph node dissection and the duration of catheter withdrawal were not statistically significant( P > 0. 05). The incidence of incision infection in the observation group was significantly lower than that in the control group( P <0. 05). There was no significant difference in the incidence of anastomosis bleeding and incision dehiscence( P > 0. 05). The patients were followed-up for 36 to 72 months,with an average of( 50. 34 ± 4. 34) months. There was no significant difference in distant metastasis rate,local recurrence rate,tumor-free survival rate and 1-year and 3-year survival rates between the two groups( P > 0. 05). Conclusion Minimal invasive CME performed in the laparoscope in the treatment of colon cancer can achieve the same result of lymph node dissection compared with the conventional laparotomy. It has the advantage of less trauma,faster recovery time,and it can significantly reduce the rate of nosocomial infection.