完整结肠系膜切除术与传统根治术治疗结肠癌的对比研究

目的比较完整结肠系膜切除术（CME）与传统根治术治疗结肠癌的短期疗效和安全性。方法回顾性分析2009年11月至2011年8月间在北京大学人民医院胃肠外科接受CME手术治疗的54例结肠癌患者（CME组）的临床资料,并选取2008年1月至2009年10月间同一手术治疗组施行传统结肠癌根治术的38例结肠癌患者作为对照组．比较两组患者的短期治疗效果和安全性。结果CME组淋巴结清扫数量为（22．2±8．0）枚,明显多于对照组f（18．6±4．7）枚,P〈0．05];其中Ⅰ期和Ⅱ期病例两组间淋巴结清扫数量的差异无统计学意义（P〉0．05）,Ⅲ期病例CME组淋巴结清扫数量明显增多（23．8＋7．6）枚比（16．7＋3．6）枚,P〈0．01];但两组Ⅲ期患者阳性淋巴结数和阳性淋巴结率的差异均无统计学意义（P〉0．05）。两组间手术时间、术后排气排粪时间、术后住院时间及术后并发症发生率比较,差异均无统计学意义（P〉0．05）;但术中出血量CME组显著少于对照组（中位数100ml比115ml,P〈0．05）。结论CME手术可以整块、彻底地切除癌灶和系膜组织,从而达到清扫淋巴结的最大化。尽管CME切除范围大,但并不会增加手术风险和术后并发症发生率．术后短期疗效良好。

Complete mesocolic excision versus traditional radical resection in colon cancer

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 inthe 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 andpostoperative complications are not increased and the short-term efficacy is good.