基于膜解剖的腹腔镜右半结肠癌根治术与传统腹腔镜手术疗效的对比研究  

Effect of laparoscopic radical resection based on membrane anatomy vs traditional laparoscopic procedure for the treatment of right colonic cancer

作　　者：姜慧员[1] 赵前 高晟[1] 王立春 马健 焦帅 江波[1] Jiang Huiyuan;Zhao Qian;Gao Sheng;Wang Lichun;Ma Jian;Jiao Shuai;Jiang Bo(Department of Colorectal Surgery,Shanxi Province Cancer Hospital/Shanxi Hospital Affiliated to Cancer Hospital,Chinese Academy of Medical Sciences,Cancer Hospital,Shanxi Medical University,Taiyuan 030013,China;Department of General Surgery,Yangquan First People's Hospital,Yangquan 045000,China)

机构地区：[1]山西省肿瘤医院、中国医学科学院肿瘤医院、山西医院、山西医科大学附属肿瘤医院结直肠外科,太原030013 [2]阳泉市第一人民医院普外科,阳泉045000

出　　处：《中华普通外科杂志》2024年第8期577-583,共7页Chinese Journal of General Surgery

摘　　要：目的比较膜解剖理念下的腹腔镜右半结肠癌根治术(CME+D3)与传统腹腔镜右半结肠癌根治术(CME/D3)的疗效。方法采用回顾性队列研究方法,收集2018年1月至2020年6月中国医学科学院肿瘤医院山西医院结直肠外科行腹腔镜右半结肠癌根治术的180例患者的临床资料,其中传统腹腔镜右半结肠癌根治术(CME/D3)患者120例(传统手术组),膜解剖腹腔镜右半结肠癌根治术(CME+D3)患者60例(膜解剖手术组),比较两组患者术后一般情况、术后并发症以及疗效。结果与传统手术组相比,膜解剖手术组减少了术中出血量[(79.3±16.7)ml比(103.6±20.8)ml,t=-3.894,P<0.001],增加了淋巴结清扫数量[(27.0±5.1)个比(25.1±6.2)个,t=2.138,P=0.034];膜解剖手术组的手术标本切面分级优于传统手术组(χ^(2)=4.146,P=0.042),但手术时间略长于传统手术组[(161.1±18.4)min比(142.6±19.5)min,t=-6.166,P<0.001]。两组标本切除长度、术后排气时间、住院时间、术后并发症发生率、30 d内非计划再手术、30 d内再入院、30 d内死亡病例相比差异均无统计学意义(均P>0.05)。中位随访时间36.7(5.3~48.7)个月,两组总体生存率差异无统计学意义(P>0.05),但两组无病生存率差异有统计学意义(χ^(2)=4.246,P=0.039)。结论基于膜解剖的腹腔镜右半结肠癌根治术(CME+D3)较传统腹腔镜右半结肠癌根治术(CME/D3)减少了术中出血量,提高了淋巴结清扫数量及标本质量,具有相同的手术安全性,并且有更高的1、3年无病生存率,肿瘤学治疗效果更好。ObjectiveTo compare the clinical efficacy of laparoscopic right colon cancer radical resection(CME+D3,60 cases)based on membrane anatomy and traditional laparoscopic right colon cancer radical resection(CME/D3,120 cases).MethodsA retrospective cohort study was used to collect the consecutively admitted cases undergoing laparoscopic radical right colon cancer resection at the Department of Colorectal Surgery,Shanxi Hospital from Jan 2018 to Jun 2020.The postoperative data,postoperative complications,follow-up outcomes were compared between the two groups.ResultsCompared with the CME/D3 group,that the based on membrane anatomy(CME+D3)group had a decreased intraoperative blood loss[(79.3±16.7)ml vs.(103.6±20.8)ml,t=-3.894,P<0.001],and more lymph node harvest[(27.0±5.1)vs.(25.1±6.2),t=2.138,P=0.034];The sectional grading of surgical specimens was also better than that in the traditional operation group(χ^(2)=4.146,P=0.042);while the operation time was slightly longer than that of the traditional operation group[(161.1±18.4)minutes vs.(142.6±19.5)minutes,t=-6.166,P<0.001].There was no significant difference in the length of specimen resection,postoperative exhaust time,hospital stay,incidence of postoperative complications,proportion of unplanned reoperation within 30 days,re-admission within 30 days,and mortality within 30 days(all P>0.05).The median follow-up time was 36.7(5.3-48.7)months,and there was no significant difference in overall survival rates between the two groups(P>0.05);The difference in disease-free survival rates between the two groups is significant(χ^(2)=4.246,P=0.039).ConclusionsCompared with the traditional laparoscopic right colon cancer radical surgery(CME/D3),laparoscopic radical resection of right colon cancer(CME+D3)based on membrane anatomy reduces intraoperative bleeding,improves the number of lymph node dissection and specimen quality,and has higher 1-year and 3-year disease-free survival rate.

关 键 词：结肠肿瘤 结肠系膜 结肠切除术 腹腔镜 

分 类 号：R735.35[医药卫生—肿瘤]