CAJ | 학술논문

目的比较完整结肠系膜切除术(CME)与传统根治术治疗结肠癌的短期疗效和安全性.方法回顾性分析2009年11月至2011年8月间在北京大学人民医院胃肠外科接受CME手术治疗的54例结肠癌患者(CME组)的临床资料,并选取2008年1月至2009年10月间同一手术治疗组施行传统结肠癌根治术的38例结肠癌患者作为对照组,比较两组患者的短期治疗效果和安全性.结果 CME组淋巴结清扫数量为(22.2±8.0)枚,明显多于对照组[(18.6±4.7)枚,P＜0.05]；其中Ⅰ期和Ⅱ期病例两组间淋巴结清扫数量的差异无统计学意义(P＞0.05),Ⅲ期病例CME组淋巴结清扫数量明显增多[(23.8±7.6)枚比(16.7±3.6)枚,P＜0.01]；但两组Ⅲ期患者阳性淋巴结数和阳性淋巴结率的差异均无统计学意义(P＞0.05).两组间手术时间、术后排气排粪时间、术后住院时间及术后并发症发生率比较,差异均无统计学意义(P＞0.05)；但术中出血量CME组显著少于对照组(中位数100 ml比115 ml,P＜0.05).结论 CME手术可以整块、彻底地切除癌灶和系膜组织,从而达到清扫淋巴结的最大化.尽管CME切除范围大,但并不会增加手术风险和术后并发症发生率,术后短期疗效良好.
목적 비교완정결장계막절제술(CME)여전통근치술치료결장암적단기료효화안전성.방법 회고성분석2009년11월지2011년8월간재북경대학인민의원위장외과접수CME수술치료적54례결장암환자(CME조)적림상자료,병선취2008년1월지2009년10월간동일수술치료조시행전통결장암근치술적38례결장암환자작위대조조,비교량조환자적단기치료효과화안전성.결과 CME조림파결청소수량위(22.2±8.0)매,명현다우대조조[(18.6±4.7)매,P＜0.05]；기중Ⅰ기화Ⅱ기병례량조간림파결청소수량적차이무통계학의의(P＞0.05),Ⅲ기병례CME조림파결청소수량명현증다[(23.8±7.6)매비(16.7±3.6)매,P＜0.01]；단량조Ⅲ기환자양성림파결수화양성림파결솔적차이균무통계학의의(P＞0.05).량조간수술시간、술후배기배분시간、술후주원시간급술후병발증발생솔비교,차이균무통계학의의(P＞0.05)；단술중출혈량CME조현저소우대조조(중위수100 ml비115 ml,P＜0.05).결론 CME수술가이정괴、철저지절제암조화계막조직,종이체도청소림파결적최대화.진관CME절제범위대,단병불회증가수술풍험화술후병발증발생솔,술후단기료효량호.
Objective To compare the short-term efficacy and safety between complete mesocolic excision (CME) and traditional radical resection in colon cancer.Methods Between January 2008 and August 2011,92 patients undergoing elective open surgery for colon were included in the study.CME was performed in 54 patients in the period from November 2009 to August 2011.The other 38 patients underwent traditional radical resection from January 2008 to October 2009.Short-term outcomes were compared between the patients of two different time periods.Results Lymph nodes retrieved in the CME group (22.2±8.0) were significant more than that in the control group (18.6±4.7)(P＜0.05).In patients with stage Ⅲ cancer,CME group was associated with higher lymph node counts (23.8±7.6 vs.16.7±3.6,P＜0.01),however,there were no significant differences for those with stage Ⅰ and stage Ⅱ cancer (P＞0.05).The number of positive lymph nodes and metastatic lymph node ratio(LNR) for stage Ⅲ patients in two groups were not significantly different (P＞0.05).There were no differences in operation time,time to first bowel movement,hospital stay,and postoperative complications between the two groups (P＞0.05).However,intraoperative blood loss in the CME group was significantly reduced (median,100 vs.115 ml,P＜0.05).Conclusions CME can achieve en-bloc resection of the tumor and mesocolon,and have optimal lymph nodes harvest.Despite wider resection extent with CME technique,the surgical risk and postoperative complications are not increased and the short-term efficacy is good.