结肠中血管根部切断在右侧结肠癌根治术中的价值  

Value of ligating the middle colic artery from the root in radical surgical treatment of right hemicolon cancer

作　　者：李东华[1] 史荣亮[1] 黄梁[1] 赵任[1] 张浩波[1] 

机构地区：[1]上海交通大学附属瑞金医院普通外科上海消化外科研究所,上海200025

出　　处：《中华胃肠外科杂志》2009年第3期261-263,共3页Chinese Journal of Gastrointestinal Surgery

摘　　要：目的评估右侧结肠癌根治术中常规根部切断结肠中血管的远期疗效。方法将1981年1月至2004年12月间在我院行右侧结肠癌根治术的患者308例按手术的不同方法，将患者分为两组：A组（103例，1996年1月至2004年12月间），常规根部切断结肠中血管，清除结肠中血管周围组织；B组（205例，1981年1月至1995年12月间）仅切断结肠中血管右侧支；对两组患者手术的安全性和随访结果进行比较分析。结果A组和B组手术死亡均为1.0％，吻合口瘘发生率分别为2.9％和2.4％，腹腔淋巴瘘发生率分别为8.7％和5.9％，胃潴留发生率分别为9.7％和5.9％，其他并发症发生率分别为4.9％和3.9％；两组比较，差异均无统计学意义（P〉0.05）。254例（82.5％）获得随访，随访时间8-60个月。A组1、3年复发率分别为1.9％和13.6％，B组则分别为19.0％和24.9％，两组比较，差异有统计学意义（P〈0.05）。5年生存率A组为（78.3±3.4）％；B组为（64.8±2.8）％；两组比较，差异也有统计学意义（P〈0.05）。结论右侧结肠癌根治术中，常规根部切断结肠中血管，不增加手术并发症，可明显减少术后1、3年复发率，提高5年生存率。Objective To compare the long-term outcome of ligating the middle colic artery in radical surgical treatment of right hemicolon cancer. Methods The operation safety, complications and short-term outcome between two groups of patients undergone either ligating the middle colic artery from its root （A group） or ligating the middle colic artery from its right branch （B group） in right hemicolectomy for colon cancer. Results Between January 1981 and December 2004, 308 patients underwent radical right hemicolectomy in which 103 patients were treated by ligating the middle colic artery from its roots （Jan. 1996 to Dec. 2004, A group）, and 205 patients via ligating the middle colic artery from the roots of its right branch （Jan. 1981 to Dec. 1995, B group）. The complications were compared between the two groups（P〉0.05）. The mean follow-up time of A and B group were（50.1±7.2） months and （49.1±7.2） months respectively. Local recurrences of 1-year, 3-year and cumulative survival probability at the 60th month in group A were 1.9%, 13.6% and （78.3±3.4）% respectively, which were significantly better than 19.0%, 24.9% and （64.8±2.8）% in group B （P〈0.05）. Conclusion Ligating the middle colic artery from its root in right hemicolectomy can be performed safely and effectively, which is to be highly recommended in curative resection of right colon.

关 键 词：结肠肿瘤 外科手术 血管 无病生存 

分 类 号：R735[医药卫生—肿瘤]