保留神经的鞘外游离技术在腹腔镜右半结肠癌D3根治术中的近远期疗效分析:基于倾向性评分匹配的回顾性队列研究  

Short-term and long-term outcomes of nerve-sparing sheath outside-sheath separation technique in D3 radical resection for right-sided colon cancer under laparoscope:A retrospective cohort study based on propensity score matching

作　　者：唐新 刁德昌[2] 廖伟林 林佳鑫 汪佳豪 李文娟[1] 谢嘉欣 敖琳 李洪明[2] 易小江 卢新泉 冯晓创 Tang Xin;Diao Dechang;Liao Weilin;Lin Jiaxin;Wang Jiahao;Li Wenjuan;Xie Jiaxin;Ao Lin;Li Hongming;Yi Xiaojiang;Lu Xinquan;Feng Xiaochuang(The Second Clinical Medical School,Guangzhou University of Chinese Medicine,Guangzhou 510405,China;Department of Gastrointestinal Surgery,Guangdong Hospital of Traditional Chinese Medicine,Guangzhou 510120,China)

机构地区：[1]广州中医药大学第二临床医学院,510405 [2]广东省中医院胃肠外科,广州510120

出　　处：《中华结直肠疾病电子杂志》2023年第5期372-380,共9页Chinese Journal of Colorectal Diseases(Electronic Edition)

基　　金：广州市科技计划项目(202002030436,202102010240)。

摘　　要：目的探讨保留神经的鞘外游离技术在腹腔镜右半结肠癌D3根治术中的围手术期有效性、安全性及远期生存。方法回顾性分析广东省中医院胃肠肿瘤中心2016年1月至2021年12月行腹腔镜右半结肠癌D3根治术(动脉入路)的148例患者的临床资料,根据是否保留完整肠系膜上动脉血管鞘,分为鞘内游离组(36例)和鞘外游离组(112例),两组通过倾向性评分匹配法进行1:1匹配,对比分析手术时间、出血量、术中血管损伤、术后并发症的发生率,对肠系膜上动脉血管鞘进行病理学检查,使用示踪剂对鞘外游离组进行淋巴示踪,对比分析两组患者3年总生存、无病生存情况。结果倾向性评分匹配后,鞘外游离组与鞘内游离组各36例患者匹配成功,两组基线资料具有可比性(均P>0.05);鞘外游离组对比鞘内游离组术中出血量较少[45(20.0,50.0)mL vs.80(50.0,100.0)mL,Z=-2.743,P=0.006],术后住院时间较短[6(5,9)d vs.7(6,10)d,Z=-2.288,P=0.022];鞘外游离组与鞘内游离组总获取淋巴结数目[(22.5±8.3)枚vs.(19.7±10.0)枚]、阳性淋巴结数目[0(0,1)枚vs.0(0,1)枚]对比差异均无统计学意义(均P>0.05);鞘外游离组对比鞘内游离组术后腹泻发生率(11.1%vs.44.4%,χ^(2)=9.969,P=0.002)、淋巴漏发生率(8.3%vs.33.3%,χ^(2)=6.821,P=0.009)较低;肠系膜上动脉血管鞘病理学检查可见血管鞘内含有神经细胞的神经纤维,未发现淋巴组织结构,淋巴结示踪未见血管鞘内显影;鞘外游离组与鞘内游离组3年总生存率(88.1%vs.89.5%)、3年无病生存率(74.0%vs.85.4%)对比差异均无统计学意义(均P>0.05)。结论右半结肠癌D3根治术中保留神经的鞘外游离技术安全可行,可显著降低术中出血量,缩短术后住院时间,降低术后腹泻及淋巴漏的发生率,且不影响患者远期预后。Objective To evaluate the perioperative efficacy,safety and long-term outcome of nerve-sparing sheath outside-sheath separation technique in D3 radical resection for right-sided colon cancer under laparoscope.Methods The clinical data of 148 patients underwent D3 radical resection for right-sided colon cancer under laparoscop(arterial approach)in Gastrointestinal Cancer Center of Guangdong Hospital of Traditional Chinese Medicine from January 2016 to December 2021 were retrospectively analyzed.According to whether the sheath of superior mesenteric artery was preserved,the patients were divided into inside-sheath separation group(36 cases)and outside-sheath separation group(112 cases).The two groups were matched 1∶1 by the propensity score matching.The operation time,blood loss,intraoperative vascular injury,and postoperative complications were compared and analyzed.Pathological examination of the sheath of the superior mesenteric artery was conducted,and the lymphatic tracer was used in the outside-sheath separation group,and the 3-year survival and 3-year disease-free survival of the two groups were compared and analyzed.Results After propensity score matching,thirty-six patients in each group were successfully matched.The baseline characteristics were comparable between two groups(all P>0.05).The intraoperative blood loss was less in the outside-sheath separation group than in the inside-sheath separation group[45(20.0,50.0)mL vs.80(50.0,100.0)mL,Z=-2.743,P=0.006].Postoperative duration of hospitalization was shorter[6(5,9)d vs.7(6,10)d,Z=-2.288,P=0.022];There was no significant difference in the total number of lymph nodes[(22.5±8.3)vs.(19.7±10.0)]and the number of positive lymph nodes[0(0,1)vs.0(0,1)]between outside-sheath separation and inside-sheath separation groups(P>0.05).The incidence of postoperative diarrhea(11.1%vs.44.4%,χ^(2)=9.969,P=0.002)and the incidence of lymphatic leakage(8.3%vs.33.3%,χ^(2)=6.281,P=0.009)were lower in the outside-sheath separation.Pathological examination of the sheath o

关 键 词：结肠肿瘤 右半结肠肿瘤 腹腔镜 保留神经的鞘外游离技术 腹泻 淋巴漏 远期生存 

分 类 号：R735.35[医药卫生—肿瘤]