右侧完整结肠系膜切除术对右半结肠癌病人远期预后的影响  

Effect of right complete mesocolic excision on long-term prognosis of patients with right colon cancer

作　　者：李飞[1] 赵柯[1] 王翔 LI Fei;ZHAO Ke;WANG Xiang(Department of General Surgery,Jurong People's Hospital,Zhenjiang,Jiangsu 212400,China)

机构地区：[1]句容市人民医院普外科,江苏镇江212400

出　　处：《安徽医药》2022年第3期516-519,共4页Anhui Medical and Pharmaceutical Journal

基　　金：江苏省卫生计生委2015年度面上科研课题(H201502)

摘　　要：目的探讨右侧完整结肠系膜切除术(CME)对右半结肠癌病人远期预后的影响。方法选择2010年1月2013年9月在句容市人民医院同一组医师实施手术治疗的右侧结肠癌病人213例进行回顾性分析,其中CME病人101例,传统手术切除112例。查阅病人病历,记录病人性别、年龄、病理类型等基线资料;记录病人术后腹泻、慢性疼痛等症状,查阅病人随访记录;计算病人5年生存率和5年无瘤生存率。结果CME和传统手术组病人性别、年龄、体质量指数、美国麻醉医师协会(ASA)分级、新辅助化疗、辅助化疗、肿瘤部位、T分期、N分期、国际抗癌联盟(UICC)分期等临床基线资料相比较均差异无统计学意义(P>0.05)。传统切除术和CME组病人腹腔镜手术比例、引流管拔除时间、排气时间、住院时间等相比较均差异无统计学意义(P>0.05)。CME组淋巴结清扫数量[(39.2±4.8)个]高于传统手术组[(23.6±6.2)个](P<0.05)。传统切除术和CME组病人吻合口瘘、不完全肠梗阻、切口裂开、切口感染等近期并发症发生率相比较均差异无统计学意义(P>0.05)。CME组病人≥4次腹泻/天发生率17.82%(18/101)高于传统手术8.04%(9/112)(P<0.05)。两组远期结肠相关慢性疼痛发生率差异无统计学意义(P>0.05)。结论右侧CME可获得最大化淋巴结清扫,改善病人的5年生存率和5年无瘤生存率,但有增加远期腹泻发生率的风险,术中应注重对神经丛的保护,以降低远期腹泻的发生率。Objective To investigate the effect of right complete mesocolic excision(CME)on the long-term prognosis of right colon cancer patients.Methods Two hundred and thirteen patients with right colon cancer who were operated by the same group of doctors in Jurong People's Hospital from January 2010 to September 2013 were selected for retrospective analysis.Among the patients,101 cases were CME patients,112 cases were traditional surgical resection.Patient medical records was checked,gender,age,pathological type and other baseline data of patient were recorded.The symptoms of postoperative diarrhea and chronic pain were recorded.The patient's follow-up records were reviewed.The 5-year survival rate and 5-year tumor free survival rate were calculated.Results There was no significant difference between CME and traditional operation group in terms of gender,age,body mass index,ASA grade,neoad⁃juvant chemotherapy,adjuvant chemotherapy,tumor location,T stage,N stage,UICC stage(P>0.05).There was no significant differ⁃ence in laparoscopic operation proportion,drainage tube removal time,exhaust time and hospitalization time between the traditional re⁃section group and CME Group(P>0.05).The number of lymph node dissection in CME group[(39.2±4.8)nodes]was higher than that in the traditional operation group[(23.6±6.2)nodes](P<0.05).There was no significant difference in the incidence of recent complica⁃tions including anastomotic leakage,incomplete intestinal obstruction,incision dehiscence,and incision infection between the tradition⁃al resection group and CME group(P>0.05);the incidence of diarrhea≥4 times/d in CME group[17.82%(18/101)]was higher than that in traditional operation[8.04%(9/112)](P<0.05).There was no significant difference in the incidence of long-term colon related chronic pain between the two groups(P>0.05).Conclusions CME on the right side can maximize lymph node dissection,improve the 5-year survival rate and 5-year tumor free survival rate of patients,but it has the risk of increasing the incide

关 键 词：结肠肿瘤 结肠切除术 肠系膜 淋巴结切除术 完整结肠系膜切除术 预后 

分 类 号：R735.35[医药卫生—肿瘤]