CAJ | 학술논문

目的：比较腹腔镜下CME与开腹D3根治在右半结肠癌根治中外科肿瘤学质量。方法选取山西省人民医院2010年2月至2013年10月间收治的右半结肠腺癌患者共87例，前瞻性非随机实施腹腔镜全系膜切除术（Laparoscopic complete mesocolon excision ，L-CME，n＝45）和同期开腹D3根治术（Laparotomy D3 resection，L-D3R，n＝42），根据术中外科平面和结肠标本量化评估外科质量。结果 L-CME组外科平面分级略高于D3组但统计学差异不显著（84．4％v73．8％，P＞0．05），但获取淋巴结（28．73v24．43，P＜0．01），切除系膜面积（14592．49v10953．42mm2，P＜0．01）及结肠切除（24．33v18．33cm，P＜0．01）均高于D3组。结论两种手术都有较好系膜切除平面，但L-CME更符合系膜平面解剖学特点，从而提高了外科质量参数。
목적：비교복강경하CME여개복D3근치재우반결장암근치중외과종류학질량。방법선취산서성인민의원2010년2월지2013년10월간수치적우반결장선암환자공87례，전첨성비수궤실시복강경전계막절제술（Laparoscopic complete mesocolon excision ，L-CME，n＝45）화동기개복D3근치술（Laparotomy D3 resection，L-D3R，n＝42），근거술중외과평면화결장표본양화평고외과질량。결과 L-CME조외과평면분급략고우D3조단통계학차이불현저（84．4％v73．8％，P＞0．05），단획취림파결（28．73v24．43，P＜0．01），절제계막면적（14592．49v10953．42mm2，P＜0．01）급결장절제（24．33v18．33cm，P＜0．01）균고우D3조。결론량충수술도유교호계막절제평면，단L-CME경부합계막평면해부학특점，종이제고료외과질량삼수。
Objective To compare the surgical quality betweenlaparoscopic complete mesocolon excision and open D3 lymphadenectomy in right-sided colon cancer .Methods The clinical data of 87 patients with right-sided colon adenocarcinoma who underwent either L-CME ( 45cases ) or open D3 lymphadenectomy(42cases) from February 2010 to October 2013 were collected .The surgical quality of anatomic planes and completeness of excised mesocolon were assessed through the surgical specimens obtained.Results L-CME was slightly higher but not significant in mesocolic plane dissection rate (84.4%vs 73.8%,P>0.05).L-CME removed longer bowel (24.33cm vs 18.33cm,P<0.01),more mesocolon (14592.49mm2 vs 10953.42mm2,P <0.01) and more lymph nodes (28.73vs 24.43,P <0.01).The distancefrom artery ligationsite to closest intestinal wall or tumor in L-CMEgroupwas significantly longer (89. 69 mm vs 79.55 mm,P<0.01;111.82 mm vs 102.31mm,P<0.01).Conclusion Bothsurgical methods showed good mesocolic plane dissection rate .But L-CME increased the completeness of mesocolon excised andquality of lymphadenectomy .L-CME was surgically superior to D 3 lymphadenectomyand might be a standard procedure for colon cancer .