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中华普外科手术学杂志(电子版) ›› 2022, Vol. 16 ›› Issue (05) : 506 -509. doi: 10.3877/cma.j.issn.1674-3946.2022.05.011

论著

不同淋巴结清扫内侧界限对右半结肠癌腹腔镜根治术近中期随访评价影响
王平1, 张汝一1,()   
  1. 1. 550004 贵阳,贵州医科大学;550004 贵阳,贵州医科大学附属医院肛肠科
  • 收稿日期:2021-05-12 出版日期:2022-10-26
  • 通信作者: 张汝一

The influence of different medial boundaries of lymph node dissection on the follow-up evaluation of laparoscopic radical resection of right colonic cancer in the early and middle stages

Ping Wang1, Ruyi Zhang1,()   

  1. 1. Guizhou Medical University, Guiyang Guizhou Province 550004, China; Department of Anorectal Medicine, Affiliated Hospital of Guizhou Medical University, Guiyang Guizhou Province 550004, China
  • Received:2021-05-12 Published:2022-10-26
  • Corresponding author: Ruyi Zhang
  • Supported by:
    Guizhou medical and health science and technology plan project(20180472)
引用本文:

王平, 张汝一. 不同淋巴结清扫内侧界限对右半结肠癌腹腔镜根治术近中期随访评价影响[J/OL]. 中华普外科手术学杂志(电子版), 2022, 16(05): 506-509.

Ping Wang, Ruyi Zhang. The influence of different medial boundaries of lymph node dissection on the follow-up evaluation of laparoscopic radical resection of right colonic cancer in the early and middle stages[J/OL]. Chinese Journal of Operative Procedures of General Surgery(Electronic Edition), 2022, 16(05): 506-509.

目的

探讨不同淋巴结清扫内侧界限对右半结肠癌腹腔镜根治术近中期随访的影响。

方法

回顾性队列研究2015年5月至2017年5月接受右半结肠癌腹腔镜根治术治疗的108例患者临床资料,根据不同淋巴结清扫内侧界限分为左侧组(肠系膜上动脉左侧)和右侧组(肠系膜上动脉右侧)。采用SPSS 24.0统计分析软件,围手术期相关指标、健康调查简表(SF-36)评分采用(

xˉ
±s)表示,行独立样本t检验;术后并发症用百分比表示,行χ2检验;累积生存率采用Log-Rank检验。P<0.05为差异有统计学意义。

结果

左侧组淋巴结清扫数量多于右侧组,手术时间长于右侧组(P<0.05);两组患者术后SF-36量表中躯体健康总评(PCS)和精神健康总评(MCS)各维度评分均高于术前,且左侧组高于右侧组,差异有统计学意义(P<0.05);两组患者术后并发症、随访3年时远处转移及生存率对比(19.0% vs. 18.0%,5.1% vs. 4.0%及96.6% vs. 94.0%),差异均无统计学意义(P>0.05)。

结论

与肠系膜上动脉右侧淋巴结清扫相比,肠系膜上动脉左侧淋巴结清扫可提升右半结肠癌腹腔镜根治术的淋巴结清扫数量,改善患者的生活质量,且近期效果良好。

Objective

To investigate the effect of different medial boundaries of lymph node dissection on the follow-up of laparoscopic radical resection of right colonic cancer.

Methods

The clinical data of 108 patients who underwent laparoscopic radical resection of right colonic cancer from May 2015 to May 2017 were studied retrospectively. According to the medial boundary of different lymph node dissections,they were divided into left group(left side of superior mesenteric artery)and right group(right side of superior mesenteric artery). SPSS 24.0 statistical analysis software was used. Perioperative related indexes and SF-36 score were expressed by(

xˉ
±s),and independent sample t test was performed;postoperative complications were expressed by percentage,and χ2 test was performed;the cumulative survival rate was tested by Log-Rank. P<0.05 was considered statistically significant.

Results

The number of lymph node dissections in the left group was more than that in the right group,and the operation time was longer than that in the right group(P<0.05). The total physical health score(PCS)and mental health(MCS)in SF-36 scale after operation in both groups were higher than those before operation,and the left group was higher than that in the right group,the difference was statistically significant(P<0.05). There were no significant differences in postoperative complications,distant metastasis and survival rate between 2 groups at 3 years follow-up(19.0% vs. 18.0%,5.1% vs. 4.0% and 96.6% vs. 94.0%,P>0.05).

Conclusion

Compared with right lymph node dissection of superior mesenteric artery,left lymph node dissection can improve the number of lymph node dissections in laparoscopic radical resection of right colonic cancer,improve the quality of life of patients,with good short-term results.

表1 108例右半结肠癌不同术式两组患者基线资料比较[(
xˉ
±s),例]
图1 离断处理回结肠血管、右结肠血管、中结肠血管 注:A=回结肠静脉;B=Henle干;C=副右结肠静脉上下支;D=右结肠动脉;E=回结肠动脉;F=中结肠动脉
图2 肠系膜上血管清扫淋巴结 注:A=右结肠动脉;B=肠系膜上静脉;C=Henle干
表2 108例右半结肠癌不同术式两组患者术中相关指标对比(
xˉ
±s)
表3 108例右半结肠癌不同术式两组患者手术前后的SF-36评分对比[(
xˉ
±s),分]
表4 108例右半结肠癌不同术式两组患者并发症发生情况对比(例)
表5 108例右半结肠癌不同术式两组患者中期远处转移及生存率对比[例(%)]
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