腹腔镜与开腹完整结肠系膜切除术的疗效比较

目的探讨腹腔镜与开腹结肠癌完整结肠系膜切除术（CME）疗效的差异。方法收集2000年9月至2008年12月问福建医科大学附属协和医院外科同一组医师连续实施的273例结肠癌CME手术患者的临床资料,其中腹腔镜手术147例,开腹手术126例,比较两组术后的肿瘤根治性及远期疗效。结果两组的近端切缘、远端切缘长度及淋巴结清扫数目的差异均无统计学意义（均P〉0．05）。273例患者中．有251例（91．9％）接受了术后随访,中位随访时间50个月。腹腔镜组与开腹组的局部复发率分别为6．1％（9／147）和7．9％（10／126）,远处转移率分别为23．8％（35／147）和16．7％（21／126）,差异均无统计学意义（均P〉0．05）。两组5年总生存率分别为69．4％和74．0％,5年无瘤生存率分别为68．5％和70．9％,差异均无统计学意义（均P〉0．05）。结论腹腔镜结肠癌CME手术能达到与开腹手术相同的肿瘤根治范围,有望成为结肠癌新的手术规范。

Comparison of efficacy between laparoscopic versus open complete mesocolic excision for colon cancer

Objective To explore the differences in long-term outcomes between laparoscopic and open complete mesocolic excision （CME） for colon cancer. Methods A total of 273 patients with colon cancer who underwent CME at the Fujian Medical University Union Hospital from September 2000 to December 2008 were divided into laparoscopic（LP, n=147） and open（OP, n=126） groups in a non-random manner. The oncologic and long-term outcomes were compared. Results No significant differences were seen in the length of distal and proximal margin, and number of lymph nodes （all P〉 0.05）. Median postoperative follow up was 50 months. Local regional recurrence rates （LP 6.1% vs. OP 7.9%） and distal metastasis rates （LP 23.8% vs. OP 16.7%） were similar between the two groups（all P〉0.05）. The 5-year overall survival rates （LP 69.4% vs. OP 74.0%, P=0.840） and 5-year disease-free survival rates （LP 68.5% vs. OP 70.9%, P=0.668） between the two groups were not statistically different. Conclusions Laparoscopic CME has the same oncologic clearance effects compared with open CME for colon cancer. It might become a new＂ standardized surgery＂ for colon cancer.