CAJ | 학술논문

目的：结直肠癌同时性肝转移（synchronous colorectal liver metastases，sCRLM）同期切除时，切口是外科医生需要考虑的技术问题。本研究旨在探讨切口对同期切除近期预后的影响。方法：回顾性分析2009年1月至2014年12月北京大学肿瘤医院肝胆胰外Ⅱ科37例同期切除的sCRLM患者的临床数据。结果：Mercedes切口（Mer）组19例，正中切口（Mid）组18例。2组间患者一般情况、大体积肝切除比例、手术时间、术中出血量、术中第一肝门阻断时间无显著性差异。正中切口组中直肠患者更多（P<0.001）。2组共发生并发症11例（32.4%），其中Mer组9例（47.4%），Mid组3例（16.7%），两组比较无显著性差异（P=0.08）。术后住院时间Mer组（22.1±9.5）d，Mid组（17.2±6.7）d，两组比较无显著性差异（P=0.08）。当患者BMI（body mass index）<25时，并发症Mer组5例（38.5%），Mid组0例（0%），两组比较有显著性差异（P=0.046）。术后住院时间Mer组（22.1±10.5）d，Mid组（15.7±5.3）d， P=0.051。结论：sCRLM患者进行同期切除时，正中切口可以满足术野暴露要求，相比Mercedes切口，对直肠术野的暴露更有优势；当BMI<25时，正中切口可能会有更好的近期预后。
목적：결직장암동시성간전이（synchronous colorectal liver metastases，sCRLM）동기절제시，절구시외과의생수요고필적기술문제。본연구지재탐토절구대동기절제근기예후적영향。방법：회고성분석2009년1월지2014년12월북경대학종류의원간담이외Ⅱ과37례동기절제적sCRLM환자적림상수거。결과：Mercedes절구（Mer）조19례，정중절구（Mid）조18례。2조간환자일반정황、대체적간절제비례、수술시간、술중출혈량、술중제일간문조단시간무현저성차이。정중절구조중직장환자경다（P<0.001）。2조공발생병발증11례（32.4%），기중Mer조9례（47.4%），Mid조3례（16.7%），량조비교무현저성차이（P=0.08）。술후주원시간Mer조（22.1±9.5）d，Mid조（17.2±6.7）d，량조비교무현저성차이（P=0.08）。당환자BMI（body mass index）<25시，병발증Mer조5례（38.5%），Mid조0례（0%），량조비교유현저성차이（P=0.046）。술후주원시간Mer조（22.1±10.5）d，Mid조（15.7±5.3）d， P=0.051。결론：sCRLM환자진행동기절제시，정중절구가이만족술야폭로요구，상비Mercedes절구，대직장술야적폭로경유우세；당BMI<25시，정중절구가능회유경호적근기예후。
Objective:To discuss the role of incision for short-term outcomes of simultaneous resection in synchronous colorec-tal liver metastases (sCRLM). Methods:We reviewed the data of 37 patients who underwent simultaneous resection between January 2009 and December 2014 in our department and compared the short-term outcomes between Mercedes and midline incisions. Results:Mercedes and midline incisions were used in 19 and 18 patients, respectively. The two groups showed similarities in patient characteris-tics, major hepatectomy, surgery time, blood loss, and hilar block time. The midline group comprised more rectal cancer patients (P<0.001). The two groups did not differ significantly in complication incidence (47.4%vs. 16.7%, P=0.08) and postoperative stay time (22.1 ± 9.5 d vs. 17.2 ± 6.7 d, P=0.08). At body mass index (BMI)<25, the complication incidence (P=0.046) and postoperative stay time (P=0.051) were lower in the midline group than in the Mercedes group. Conclusion:Midline incision provided similar exposure in simultaneous resection for sCRLM and was better than Mercedes incision in rectal cancer patients. Patients with midline incision may attain better short-term outcomes if BMI is<25.