CAJ | 학술논문

目的：通过与开腹手术的比较，探讨对Ⅱ/Ⅲ期右半结肠癌患者实施腹腔镜完整系膜切除术/D3根治术的安全性和可行性。方法：对2008年1月至2011年12月中国医科大学附属盛京医院178例右半结肠癌患者分别实施完整系膜切除术/D3根治术，其中开腹组82例、腹腔镜组96例，比较两组间的并发症、生存率以及肿瘤复发情况。结果：腹腔镜组的术中出血量要少于开腹组，切口长度也明显较开腹组短，术后首次排气时间较后者快，住院时间也较短（P<0.001），两组的手术时间以及检出的淋巴结数无差异（P>0.05）。术后吻合口漏、切口感染、出血、尿潴留、肠梗阻、淋巴漏的并发症两组并无显著性差异（P>0.05）。中位随访56个月，开腹组和腹腔镜组的总生存率分别为89.0%和91.7%（P=0.357），无瘤生存率分别为94.6%和94.3%（P=0.823），差异均无统计学意义。结论：对Ⅱ/Ⅲ期右半结肠癌患者实施腹腔镜完整系膜切除术/D3根治术是安全和可行的。
목적：통과여개복수술적비교，탐토대Ⅱ/Ⅲ기우반결장암환자실시복강경완정계막절제술/D3근치술적안전성화가행성。방법：대2008년1월지2011년12월중국의과대학부속성경의원178례우반결장암환자분별실시완정계막절제술/D3근치술，기중개복조82례、복강경조96례，비교량조간적병발증、생존솔이급종류복발정황。결과：복강경조적술중출혈량요소우개복조，절구장도야명현교개복조단，술후수차배기시간교후자쾌，주원시간야교단（P<0.001），량조적수술시간이급검출적림파결수무차이（P>0.05）。술후문합구루、절구감염、출혈、뇨저류、장경조、림파루적병발증량조병무현저성차이（P>0.05）。중위수방56개월，개복조화복강경조적총생존솔분별위89.0%화91.7%（P=0.357），무류생존솔분별위94.6%화94.3%（P=0.823），차이균무통계학의의。결론：대Ⅱ/Ⅲ기우반결장암환자실시복강경완정계막절제술/D3근치술시안전화가행적。
Objective: To evaluate the feasibility and safety of laparoscopic complete mesocolic excision (CME)/D3 radical operation in stage Ⅱ/Ⅲ right colon cancer by comparing this approach with open surgery. Methods: A total of 178 patients with stageⅡ/Ⅲ right hemicolon cancer were admitted to the Shengjing Hospital, China Medical University, Shenyang. They underwent CME/D3 radical operation between January 2008 and December 2011. These cases were divided into two groups, namely, the oapen group (n=82) and the laparoscopic group (n=96). Data on complications, survival, and recurrence were compared between the two groups. Results: The laparoscopic group (P<0.001) showed less blood loss, smaller length of incision, faster first flatus, and shorter hospital stay than the open group. The operation time and number of lymph nodes harvested were similar between the groups (P>0.05). No significant differences were found in the complications brought about by anastomotic leakage, wound infection, bleeding, urinary retention, ileus, and chyle between the two groups (P>0.05). After a median follow-up of 56 months, the overall survival rates (89.0%vs. 91.7% , P=0.357) and disease-free survival rates (94.6% vs. 94.3% , P=0.823) in the two groups were similar. Conclusion:Laparoscopic CME/D3 operation is feasible and safe in the treatment of the stage Ⅱ/Ⅲ right hemicolon cancers.