腹腔镜辅助与开腹全结肠系膜切除术治疗老年人右半结肠癌疗效和安全性的比较

 目的 分析比较腹腔镜辅助全结肠系膜切除(laparoscopy-assisted complete mesocolic excision, LCME)与开腹全结肠系膜切除(open complete mesocolic excision, OCME)治疗老年人右半结肠癌的可行性、安全性及临床疗效观察。方法 回顾性分析河北大学附属医院2011-04至2015-09收治的老年右半结肠癌170例的临床资料,其中LCME组和OCME组各85例,比较两组患者的术中、术后临床资料及随访资料。结果 两组患者的术中出血量、初次排气时间、初次进流食时间、平均住院时间,LCME组患者明显少于OCME组,差异有统计学意义(均P<0.05)。两组患者手术质量分级、手术时间、清扫淋巴结数目、术后心脑血管意外发生率及未见统计学差异(均P>0.05)。术后随访时间为48个月,两组患者的复发率和转移率差异无统计学意义。结论 腹腔镜辅助全结肠系膜切除术(LCME)治疗老年患者右半结肠癌的安全性、可行性、根治性,以及短期生存均不逊于传统开腹手术。

Comparison of efficacy and safety between laparoscopic assisted and open total mesorectal excision in the treatment of right colon cancer in the elderly

Objective To evaluate the safety and feasibility of laparoscopic-assisted CME (laparoscopic complete mesocolic excision, LCME) and open CME (open complete mesocolic excision, OCME) in the treatment of elderly patients with right colon cancer. Methods Data was collected retrospectively by reviewing the medical records of 170 patients of right-sided colon cancer who had undergone right colectomy in the Affiliated Hospital of Hebei University between April 2011 and September 2015. The elderly patients were equally divided into LCME group and OCME group based on the approach to colectomy. Demographic variables including age, gender, information on surgery,pathological findings and follow-up were collected and analyzed. Results The median blood loss, median time to anal exhaust, post-operative liquid food, and hospital stay were significantly shorter or lower in LCME group than those in OCME group (P<0.05). The difference of durations of surgery, operation quality grading、cardiac-cerebrovascular accidents,tumor diameter and the number of harvested lymph nodes were not statistically significant between the two groups (P>0.05). After follow-up of 48 months, the rate of local recurrence and distant metastasis showed no significant difference between the two groups (P>0.05). Conclusions LCME is a safe and feasible treatment for elderly patients with right colon cancer. It can facilitate the recovery of postoperative patients.