结肠癌患者完整结肠系膜切除术的应用价值

摘要

目的：探讨完整结肠系膜切除（ CME)在结肠癌患者中的应用价值。方法68例结肠癌患者按照手术方法分为CME组（n＝34)和对照组（n＝34),CME组行CME手术,对照组行传统开腹手术。观察2组手术情况、围手术期并发症、淋巴结清扫数量、复发率。结果 CME组平均手术时间（158±38) min、住院时间（13.4±4.0) d、肛门排气时间（2.3±0.5) d、术后前3 d引流量（123.3±20.5) mL、引流管拔除时间（12.3±2.5) d与对照组相比均无显著差异（P>0.05)； CME组术中出血量（112.3±35.5) mL与对照组（146.6±36.7) mL相比显著差异（P<0.05)。2组围手术期并发症发生率无显著差异（P>0.05)。 CME组TNM Ⅰ期淋巴结清扫数目（13.6±4.7)个与对照组（12.2±3.4)个相比无显著差异（P>0.05),TNM Ⅱ期（18.6±6.7)个及Ⅲ期（22.6±8.6)个均显著多于对照组（15.2±4.8)个,（16.8±6.7)个（P＝0.0190,0.0028)。 CME组术后复发率（0.0%)显著低于对照组（17.6%)（χ2＝4.5699,P＝0.0325)。结论 CME不增加结肠癌根治术的风险,且能更大范围清除淋巴结,减少肿瘤复发。%Objective To explore the value of complete mesocolic excision ( CME) for patients with colon carcinoma. Methods The 68 patients with colon carcinoma were divided into CME group (n=34) and control group (n=34) randomly. The patients in CME group were managed CME and the control group were arranged traditional open operation. The operation condition, preoperative complications, a-mount of lymph node scavenged,and the relapse rate of the 2 groups were contrasted. Results The operation period,the hospital stays,period of passage of gas by anus,the drainage volume post 3 days of operation and the period of drainage tube extraction of CME group were respec-tively(158 ± 38) min,(13. 4 ± 4. 0),(2. 3 ± 0. 5) d,(123. 3 ± 20. 5) mL,(12. 3 ± 2. 5) d,with no difference compared to control group (P>0. 05). The intraoperative bleeding volume of CME group (112. 3 ± 35. 5) mL was less than that of control group (146. 6 ± 36. 7) mL (P<0. 05). There was no difference in complication and the amount of lymph nodes scavenged of patients between 2 groups(P>0. 05). But the amount of lymph nodes scavenged of patients in TNM Ⅱ and Ⅲ of CME group (18. 6 ± 6. 7),(22. 6 ± 8. 6) was more than that of control group (15. 2 ± 4. 8),(16. 8 ± 6. 7)(P=0. 019 0,0. 002 8). The relapse rate in CME group (0. 0%) was lower than that in control group (17. 6%)(χ2 =4. 569 9,P=0. 032 5). Conclusion CME will not increase the risks of radical operation for colon carcinoma,but can scavenge more lymph nodes and decrease the tumor relapse rate.