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中华普外科手术学杂志(电子版)

中华普外科手术学杂志(电子版) ›› 2019, Vol. 13 ›› Issue (03) : 279 -282. doi: 10.3877/cma.j.issn.1674-3946.2019.03.021

所属专题： 文献；

论著

三种CME手术治疗Ⅲ期老年右半结肠癌的疗效及安全性比较
管福军1,†(), 方志华1   
  1. 1. 067000　承德市第三医院腹部外科
  • 收稿日期:2018-07-15 出版日期:2019-06-26
  • 通信作者: 管福军

Comparison of efficacy and safety of three CME procedures in the treatment of stage III elderly right colon cancer

Fujun Guan1,†(), Zhihua Fang1   

  1. 1. Department of abdominal surgery, Chengde third hospital 067000
  • Received:2018-07-15 Published:2019-06-26
  • Corresponding author: Fujun Guan
  • About author:
    Corresponding author: Guan Fujun, Email:
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管福军, 方志华. 三种CME手术治疗Ⅲ期老年右半结肠癌的疗效及安全性比较[J/OL]. 中华普外科手术学杂志(电子版), 2019, 13(03): 279-282.

Fujun Guan, Zhihua Fang. Comparison of efficacy and safety of three CME procedures in the treatment of stage III elderly right colon cancer[J/OL]. Chinese Journal of Operative Procedures of General Surgery(Electronic Edition), 2019, 13(03): 279-282.

目的

探究3D腹腔镜、2D腹腔镜与开腹三种完整全结肠系膜切除(CME)手术治疗Ⅲ期老年右半结肠癌的疗效及安全性。

方法

回顾性分析2013年1月至2017年1月90例老年右半结肠癌患者资料，根据手术方式不同分为三组，分别为3D组、2D组及开腹组，每组各30例。数据均采用SPSS21.0软件进行统计分析，手术相关指标和肿瘤标志物水平采用(±s)描述，独立t检验；术后并发症采用χ2检验分析，P<0.05时差异有统计学意义。

结果

3D组患者的手术时间明显大于开腹组(P<0.05)，术中出血量和住院时间均明显低于开腹组(P<0.05)，而与2D组患者无明显差异(P>0.05); 3D组患者的淋巴清扫数目和进食流质饮食时间均明显优于其他2组(P<0.05); 3D组患者的术后并发症总发生率最低(P<0.05)；术后第8天，三组患者的CA－125、CA19－9、CEA水平均较术前明显降低，3D组明显低于其他2组(P<0.05)。

结论

3D腹腔镜CME手术治疗Ⅲ期老年右半结肠癌安全可行，临床疗效显著，手术视野清晰，视觉效果立体，值得进一步应用推广。

关键词: 结肠肿瘤, 肠系膜, 腹腔镜检查, 剖腹术
Objective

To investigate the efficacy and safety of 3D laparoscopic, 2D laparoscopic and open laparoscopic complete mesorectal excision (CME) in the treatment of stage III elderly right colon cancer.

Methods

Retrospective analysis of 90 elderly patients with right colon cancer from January 2013 to January 2017 was divided into three groups according to different surgical methods, namely 3D group, 2D group and open group, 30 cases in each group. The data were analyzed by SPSS21.0 software. The indexes of the surgical conditions and the level of tumor markers were described by (±s) and analyzed by independent t test. Postoperative complications were described by (n, %) and analyzed by χ2 test. The difference was statistically significant at P<0.05.

Results

The operation time of the 3D laparoscopic group was significantly higher than that of the open group (P<0.05), The intraoperative blood loss and hospital stay were significantly lower than the open group (P<0.05), there was no significant difference between the patients in the 2D laparoscopic group (P>0.05); The number of lymphatic dissection and dietary fluid diet in the 3D laparoscopic group were significantly better than the other two groups (P<0.05); However, the anal recovery ventilation time and defecation time of the 3D laparoscopic group were not significantly different from the other two groups (P>0.05); The total incidence of postoperative complications in the three groups was significantly different (P<0.05), and the total incidence of postoperative complications was the lowest in the 3D laparoscopic group; On the 8th day after surgery, the levels of CA-125, CA19-9, and CEA in the three groups were significantly lower than those before surgery, the levels of CA-125, CA19-9, and CEA in the 3D laparoscopic group were significantly lower than the other two groups (P<0.05).

Conclusion

3D laparoscopic CME surgery is safe and feasible for the treatment of stage III elderly right colon cancer. The clinical effect is remarkable, the surgical field is clear, and the visual effect is three-dimensional. It is worthy of further application and promotion.

Key words: Colonic neoplasms, Mesocolon, Laparoscopy, Laparotomy
表1 90例老年右半结肠癌患者不同术式三组患者的基线资料比较(±s，例)
组别 例数 年龄(岁) 性别 肿瘤最大径(cm) 结肠肿瘤部位
男/女 回盲/肝曲/升结肠
开腹组 30 61.4±7.2 20/10 4.8±1.3 8/8/14
2D组 30 61.8±6.9 19/11 4.6±1.6 7/8/15
3D组 30 61.1±7.6 18/12 4.9±1.1 7/9/14
F/χ2值 ? 0.374 0.287 0.846 0.217
P值 ? 0.710 0.886 0.401 0.995
表2 90例老年右半结肠癌患者不同术式三组患者手术指标比较(±s)
组别 手术时间(min) 术中出血量(ml) 淋巴清扫数目(n) 肛门恢复通气时间(d) 排便时间(d) 进食流质饮食时间(d) 住院时间(d)
开腹组 170.5±20.3 148.2±21.3 19.2±5.2 4.2±1.1 5.4±1.3 6.8±1.2 15.9±2.3
2D组 225.3±23.7 92.5±17.5 22.3±6.3 3.8±1.0 5.5±1.2 5.1±1.0 11.4±2.0
3D组 234.1±24.1 93.7±18.4 26.9±6.8 3.9±1.1 5.2±1.1 4.1±1.1 10.9±1.9
Ⅰ t＝11.055 t＝9.949 t＝4.927 t＝1.056 t＝0.643 t＝9.085 t＝9.180
P＝0.000 P＝0.000 P＝0.000 P＝0.295 P＝0.523 P＝0.000 P＝0.000
Ⅱ t＝1.426 t＝0.259 t＝2.718 t＝0.368 t＝1.009 t＝3.684 t＝0.993
P＝0.159 P＝0.797 P＝0.009 P＝0.714 P＝0.317 P＝0.001 P＝0.325
表3 90例老年右半结肠癌患者不同术式三组患者术后并发症比较(例)
指标 例数 术后出血 术后切口脂肪液化 胃潴留 不完全性肠梗阻 吻合口漏 合计(%)
开腹组 30 5 2 3 3 2 15(50.0)
2D组 30 1 1 0 1 1 4(13.3)
3D组 30 1 0 0 0 0 1(3.3)
χ2值 ? 4.957 2.069 6.207 3.663 2.069 10.957
P值 ? 0.084 0.355 0.045 0.160 0.355 0.000
表4 90例老年右半结肠癌患者不同术式三组患者手术前后肿瘤标志物水平比较(±s)
组别 CA－125(kU/L) CA19－9(kU/L) CEA(μg/L)
开腹组 ? ? ?
? 术前 155.6±18.3 43.7±7.4 20.8±4.1
? 术后 63.7±14.1a，b 29.1±6.5a，b 14.7±3.6a，b
2D组 ? ? ?
? 术前 157.1±18.9 43.3±6.5 20.3±4.0
? 术后 53.4±12.7a，b 23.2±6.1a，b 10.9±3.2a，b
3D组 ? ? ?
? 术前 155.9±17.6 44.1±7.1 19.9±3.8
? 术后 44.2±10.6a 19.3±5.7a 6.9±3.5a
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