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[结肠癌的完整结肠系膜切除术与传统根治性切除术对比]

[Complete mesocolic excision versus traditional radical resection in colon cancer].

作者信息

Gao Zhi-dong, Ye Ying-jiang, Wang Shan, Yang Xiao-dong, Yin Mu-jun, Liang Bin, Jiang Ke-wei, Xie Qi-wei, Guo Peng

机构信息

Department of Gastrointestinal Surgery, Peking University People's Hospital, Beijing, China.

出版信息

Zhonghua Wei Chang Wai Ke Za Zhi. 2012 Jan;15(1):19-23.

Abstract

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.

摘要

目的

比较结肠癌全结肠系膜切除术(CME)与传统根治性切除术的短期疗效和安全性。

方法

2008年1月至2011年8月期间,92例行择期开放性结肠癌手术的患者纳入本研究。2009年11月至2011年8月期间,54例患者接受了CME手术。另外38例患者于2008年1月至2009年10月接受了传统根治性切除术。比较两个不同时间段患者的短期结局。

结果

CME组切除的淋巴结数量(22.2±8.0)显著多于对照组(18.6±4.7)(P<0.05)。在III期癌症患者中,CME组的淋巴结数量更多(23.8±7.6对16.7±3.6,P<0.01),然而,I期和II期癌症患者的淋巴结数量无显著差异(P>0.05)。两组III期患者的阳性淋巴结数量和转移淋巴结比率(LNR)无显著差异(P>0.05)。两组在手术时间、首次排便时间、住院时间和术后并发症方面无差异(P>0.05)。然而,CME组的术中出血量显著减少(中位数,100对115 ml,P<0.05)。

结论

CME能够实现肿瘤和结肠系膜的整块切除,并能获得最佳的淋巴结清扫效果。尽管CME技术切除范围更广,但手术风险和术后并发症并未增加,且短期疗效良好。

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