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中华普外科手术学杂志(电子版) ›› 2022, Vol. 16 ›› Issue (02) : 214 -217. doi: 10.3877/cma.j.issn.1674-3946.2022.02.026

论著

腹腔镜右半结肠癌根治术中以SMA与SMV为淋巴结清扫内界的对比研究
吴岑1, 俞卫卫2,()   
  1. 1. 226400 江苏南通,如东县人民医院肿瘤科
    2. 214000 江苏无锡,无锡市人民医院普通外科
  • 收稿日期:2021-04-22 出版日期:2022-04-26
  • 通信作者: 俞卫卫

Comparative study of SMA and SMV as the internal boundary of lymph node dissection in laparoscopic right hemicolectomy

Cen Wu1, Weiwei Yu2,()   

  1. 1. Rudong County People’s Hospital Oncology Department, Nantong Jiangsu Province 226400, China
    2. Wuxi People’s Hospital, Wuxi Jiangsu Province 214000, China
  • Received:2021-04-22 Published:2022-04-26
  • Corresponding author: Weiwei Yu
  • Supported by:
    Natural Science Foundation of Anhui Province(1908085MB55)
引用本文:

吴岑, 俞卫卫. 腹腔镜右半结肠癌根治术中以SMA与SMV为淋巴结清扫内界的对比研究[J/OL]. 中华普外科手术学杂志(电子版), 2022, 16(02): 214-217.

Cen Wu, Weiwei Yu. Comparative study of SMA and SMV as the internal boundary of lymph node dissection in laparoscopic right hemicolectomy[J/OL]. Chinese Journal of Operative Procedures of General Surgery(Electronic Edition), 2022, 16(02): 214-217.

目的

对比分析腹腔镜右半结肠癌根治术中以肠系膜上动脉(SMA)与肠系膜上静脉(SMV)为淋巴结清扫内界的临床效果。

方法

前瞻性纳入2014年3月至2016年3月收治的80例行腹腔镜右半结肠癌根治术的右半结肠癌患者的临床资料,采用随机数字表法将患者分为SMV组和SMA组,每组40例。两组均行腹腔镜右半结肠癌根治术。SMV组:以SMV左侧为淋巴结清扫内界,SMA组:以SMA左侧淋巴结清扫内界。选用SPSS 22.0软件处理数据,围术期相关指标等计量资料以(

xˉ
±s)表示,行独立样本t检验;术后并发症等其他非等级计数资料行χ2检验;生存分析采用Kaplan-Meier法并行Log-rank检验。P<0.05表示差异有统计学意义。

结果

SMA组淋巴结清扫数目、阳性淋巴结枚数、引流管留置时间、术后引流量较SMV组显著增多,差异均有统计学意义(P<0.05);SMA组术后并发症的总发生率较SMV组略高(30.0% vs. 22.5%),但差异无统计学意义(P>0.05);两组患者5年总生存率(77.5% vs. 90.0%)、无病生存率(72.5% vs. 87.5%)比较,差异均无统计学意义(Log Rank χ2=2.626、3.373,P=0.105、0.066)。

结论

腹腔镜右半结肠癌根治术中以SMA为淋巴结清扫内界不仅使淋巴结清扫更彻底,提高了肿瘤的根治性,而且也有利于改善患者预后,同时并未使手术风险显著增加。

Objective

To compare the clinical effect of superior mesenteric artery(SMA)and superior mesenteric vein(SMV)in laparoscopic radical right hemicolectomy.

Methods

The clinical data of 80 patients with right colon cancer who underwent laparoscopic right hemicolectomy from March 2014 to March 2016 were prospectively included. The patients were divided into SMV group and SMA group by random number table method,with 40 patients in each group. Laparoscopic right hemicolectomy was performed in both groups,In SMV group,the left side of SMV was taken as the internal boundary of lymph node dissection,while in SMA group,the left side of SMA was taken as the internal boundary of lymph node dissection. SPSS 22.0 software was used to process the data. The measurement data such as perioperative related indicators were expressed by(

xˉ
±s),and independent t test was performed;Postoperative complications and other non-grade count data were tested by χ2 test. Kaplan-meier method and log-rank test were used for survival analysis. P<0.05 indicated statistically significant difference.

Results

The number of lymph node dissection,number of positive lymph nodes,indwelling time of drainage tube and postoperative drainage volume in SMA group were significantly higher than those in SMV group(P<0.05). The incidence of postoperative complications in SMA group was slightly higher than that in SMV group(30.0% vs. 22.5%,P>0.05). During the follow-up period,the Kaplan-Meier analysis showed that there was no significant difference in 5-year overall survival rate(77.5% vs. 90.0%)and disease-free survival rate(72.5% vs. 87.5%)between the two groups(log rank χ2=2.626,3.373,P=0.105,0.066).

Conclusion

In laparoscopic right hemicolectomy,using SMA as the internal boundary of lymph node dissection not only makes lymph node dissection more thorough and improves the radical effect of tumor,but also improves the prognosis of patients,without significantly increasing the risk of operation.

表1 80例腹腔镜右半结肠癌根治术不同淋巴结清扫方法两组患者一般资料[(
xˉ
±s),例]
表2 80例腹腔镜右半结肠癌根治术患者不同淋巴结清扫方法两组围术期相关指标比较(
xˉ
±s
表3 80例腹腔镜右半结肠癌根治术不同淋巴结清扫方法两组患者术后并发症情况[例,(%)]
图1 80例腹腔镜右半结肠癌根治术不同淋巴结清扫方法两组患者5年总生存和无病生存曲线
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