中间入路与外侧入路在全结肠系膜切除右半结肠癌根治术的临床效果比较  

A comparison of clinical outcomes between medium approach and lateral approach for complete mesocolic excision(CME) in radical right hemicolectomy

作　　者：云文耀 吴礼武 刘德伟[1] 陈海涛[1] 肖康明 湛文龙[1] 

机构地区：[1]增城市新塘医院胃肠肛门外科,广州511340

出　　处：《消化肿瘤杂志（电子版）》2013年第2期92-96,共5页Journal of Digestive Oncology(Electronic Version)

基　　金：揭阳市科技计划(20130304)

摘　　要：目的观察并比较中间入路与外侧入路在右半结肠癌全结肠系膜切除术(complete mesocolic excision,CME)的手术质量及临床效果。方法分析2009年3月至2013年3月我科接受右半结肠癌根治术患者的临床资料,根治手术均按照CME的原则进行。按照手术入路的差异分为中间入路组(36例)和外侧入路组(37例)。比较两组患者手术标本切除质量及临床效果。结果中间入路组患者的手术时间、术中出血量、切缘长度与外侧入路组相似(P>0.05)。两组术后肛门排气、排便时间、拔除腹腔引流管时间、术后进食时间及术后住院时间比较,差异无统计学意义(P>0.05)。中间入路组患者手术可获取更多的淋巴结(17.83枚vs.15.82枚,P<0.05)、切除平面分级优的比例更高(91.7%vs 67.6%,P<0.05)、术后平均每天引流量更少(265.00 ml vs.310.00 ml,P<0.05)。两组患者术后无1例死亡。中间入路组与外侧入路组术后并发症发生率无显著性差异(P>0.05)。两组患者均无围手术期死亡及因术后并发症行二次手术。结论中间入路更符合CME原则指导下的右半结肠癌根治术,能获得较佳的手术解剖平面,安全性好,值得临床应用推广。Objective To investigate the differences in surgical quality and clinical effect between medium approach and lateral approach for complete mesocolic excision(CME) in radical right hemicolectomy.Methods From March 2009 to March 2013, Seventy-three patients with right colon cancer underwent radical right hemicolectomy with CME principle. The patients were divided into medium approach group(n=36) and lateral approach group(n=37) according to the different surgical approach. The surgical quality and clinical outcomes were compared between the two groups. Results There were no significant differences in age, gender, preoperative coexistent diseases, history of abdominal operation, tumor location, TNM and Dukes' stages between the two groups. No differences were found in the operation time, volume of blood loss, length of resection margin, anal exhausting time, defecation time, time for abdominal drainage tube removal, time for postoperative feeding, and hospital stay between the two groups(P >0.05). More lymph nodes(17.83 vs. 15.82,P<0.05), higher proportion of the resected specimens with excellent anatomic plane(91.7% vs. 67.6%,P<0.05), less mean daily abdominal drainage(265.00 ml vs. 310.00ml,P<0.05) were found in the medium approach group than those in the lateral approach group. There was no significant difference in postoperative morbidity between the two groups. There was no peri-operative death and reoperation for postoperative complications in the two groups. Conclusions The medium approach was in accord with radical right hemicolectomy resection under CME principle, with better anatomic plane and safety. The medium approach of CME is worthy of clinical application in the treatment of right colon cancer.

关 键 词：中间入路 全结肠系膜切除术 右半结肠癌根治术 

分 类 号：R735.35[医药卫生—肿瘤]