完整结肠系膜切除术治疗结肠癌的临床研究

目的探究完整结肠系膜切除术（CME）在治疗各种结肠癌手术中的短期效果和安全性。方法收集2011年8月～2013年8月揭阳市揭东区人民医院普通外科收治的结直肠癌患者84例，分为治疗组（51例）和对照组（33例），所有患者均通过纤维结肠镜和病理切片断诊为结肠癌。治疗组以CME治疗，对照组以传统的结肠癌手术治疗，并测定术后各项临床指标（手术时长、中位排气时间、中位排便时间、出血量、淋巴结清除数目、住院时间）和术后并发症发生率，以评价其短期效果与安全性。结果治疗组在术后出血量、中位排气时间、中位排便时间、淋巴结清除数目、住院时间5项临床效果指标上明显优于比对照组，差异均有统计学意义（P〈0．05）。外周血检测指标方面，以CD3＋、CD4＋、CD4＋／CD8＋为代表的T淋巴细胞亚群和NK细胞的活性明显高于对照组，组间差异均有统计学意义（P〈0．05）。治疗组患者复发率为7．8％（4／51），发生感染5例和吻合口瘘现象1例；对照组患者的复发率为15．2％（5／33），发生感染5例与吻合口瘘现象2例，组间差异有统计学意义（P〈0．05）。结论CME治疗结肠癌临床效果显著，且并发症复发率低，安全性较高，值得普遍推广。

Clinical study on complete mesocolic excision in the treatment of colon cancer

Objective To investigate the curative effect and safety degree of treating various types of colon cancer op- eration with complete mesocolic excision （CME）. Methods From 2011 August to 2013 August, 84 patients at Depart- ment of General Surgery in People＇s Hospital of Jiedong District in Jieyang City were selected and divided into two groups, treatment group （51 cases） and control group （31 cases）. All of them were diagnosed colon cancer by fihro--colono- scope and pathological section. The treatment group was treated with the CME and the control group was treated with traditional colon cancer operation. After operation, various clinical indexes （operation period, the median time of exhaust, the median time of defecation, amount of bleeding, the number of dissected lymph nodes, length of stay in hospital） and rate of postoperative complications were observed and compared. Results The indexes （the median time of exhaust, the median time of defecation, amount of bleeding, the number of dissected lymph nodes, length of stay in hospital） of the treatment group were much better than those of the control group, the differences were statistically significant （P 〈 0.05）. The peripheral blood examination index, the activity of T lymphocytes （CD3 ＋, CD4＋, CD4＋/CD8＋） and NK cells of the treatment group were much higher than those of the control group, the differences were statistically significant （P 〈 0.05）. The recurrence rate of treatment group was 7.8% （4/51）, infected patients were 5 cases, and anastomotic fistula phenomenon was 1 case; the recurrence rate of the control group was 15.2% （5/33）, infected patients were 5 cases, and anastomotic fistula phenomenon were 2 cases, the differences were statistically significant （P 〈 0.05）. Conclusion CME is of significant curative effect, low recurrence rate and higher safety degree. It is worthy of further clinical usage.