全结肠系膜切除术对比传统切除术治疗右半结肠癌的疗效及安全性  

Efficacy and Safety of Total Mesorectal Excision and Conventional Resection for Right Colon Cancer

作　　者：申志成 申力[1] 王守立[1] 柏巍松[1] 王志伟[1] 唐纪全[1] 赵立志[1] SHEN Zhicheng;SHEN Li;WANG Shouli(Hanzhong Central Hospital,Hanzhong,723000)

机构地区：[1]陕西省汉中市中心医院,723000

出　　处：《实用癌症杂志》2020年第7期1137-1141,共5页The Practical Journal of Cancer

基　　金：陕西省卫健委卫生健康科研项目(编号:2018C003)。

摘　　要：目的对比与分析全结肠系膜切除术与传统切除术对右半结肠癌的疗效及安全性。方法选择右半结肠癌患者124例,根据治疗方法的不同分为观察组46例与对照组78例。对照组给予传统根治术治疗,观察组给予腹腔镜下全结肠系膜切除术治疗,对比分析2组的疗效与安全性。结果观察组的手术切口长度、术中出血量少于对照组(P<0.05),淋巴结清扫数目多于对照组(P<0.05)。虽然观察组的住院费用略高于对照组(P<0.05),但是观察组的术后首次排气时间、首次排便时间、术后第1天疼痛VAS评分、开始进食时间及住院时间都显著少于(短于)对照组(P<0.05)。观察组术后腹腔出血、腹腔感染、切口感染、肺部感染与肠梗阻等并发症的总发生率为2.2%,显著低于对照组的11.5%(P<0.05)。2组术后1 d的血清TNF-α与IL-6值显著高于术前1 d与术后3 d(P<0.05),且观察组术后1 d、3 d的血清TNF-α与IL-6值显著低于对照组(P<0.05)。结论相对于传统切除术,全结肠系膜切除术在右半结肠癌患者中的应用可以获得更多的淋巴结清扫数目,还能减轻对患者的创伤,减少术后并发症的发生,同时可以减少炎症因子的释放,更能使患者获益。Objective To compare and analysis of the efficacy and safety of total colonic mesorectal excision and conventional resection for right colon cancer.Methods 124 right colon cancer patients were selected and divided into the 46 patients in the observation group and 78 patients in the control group according to the different treatment methods.The control group was treated with conventional radical mastectomy,and the observation group was treated with laparoscopic total mesorectal excision.The efficacy and safety of the two groups were recorded.Results The surgical incision length,intraoperative blood loss of the observation group were less than those of the control group(P<0.05),and the number of lymph node dissection was more than that of the control group(P<0.05).Although the hospitalization cost of the observation group was slightly higher than that of the control group(P<0.05),the observation group’s first postoperative exhaust time,first defecation time,pain VAS score on the first day after surgery,time to start eating and hospitalization time were significantly lower(shorter)than those of the control group(P<0.05).The incidence of postoperative complications including abdominal hemorrhage,abdominal infection,incision infection,pulmonary infection and intestinal obstruction was 2.2%in the observation group,which was significantly lower than 11.5%in the control group(P<0.05).The postoperative 1 d of serum levels of TNF-αand IL-6 in the 2 groups were significantly higher than those in the postoperative 3 d and preoperative 1 d(P<0.05),and the serum levels of TNF-αand IL-6 of observation group were significantly lower than the control group at postoperative 1 d and 3 d(P<0.05).Conclusion Compared with traditional resection,total mesenterectomy can obtain a higher number of lymph node dissection in patients with right colon cancer,it can reduce the trauma to patients,reduce the incidence of postoperative complications,and reduce the release of inflammatory factors,thus benefiting patients more.

关 键 词：腹腔镜 全结肠系膜切除术 右半结肠癌 并发症 

分 类 号：R735.35[医药卫生—肿瘤]