目的

探究以肠系膜上动脉（SMA）为内侧界的CME+D3根治术在进展期结肠癌患者中的临床效果。

方法

选取2020年1月至2023年12月62例进展期右半结肠癌行CME+D3根治术患者为研究对象。用随机数字表法分为对照组（n=31例）和观察组（n=31例），对照组以肠系膜上静脉（SMV）左缘为淋巴结清扫内侧界，观察组以肠系膜上动脉（SMA）左缘为淋巴结清扫内侧界。应用SPSS 27.0统计学软件进行数据分析，围手术期指标、术后病理情况等计量资料用（±s）表示，行独立样本t检验；术后并发症情况用率表示，组间比较用χ²检验。P＜0.05为差异有统计学意义。

结果

两组患者手术时间、术中出血量、术后肛门排气时间、住院时间、肿瘤直径与肿瘤分化程度相比，差异无统计学意义（P＞0.05）；观察组引流管放置时间长于对照组，术后引流量、淋巴结阳性数量与淋巴结清扫总数均多于对照组（P＜0.05）；对照组与观察组患者术后并发症总发生率对比，差异无统计学意义（19.4% vs. 6.5%，P＞0.05）；术后2年随访，两组患者累积总生存率对比，差异无统计学意义（87.1% vs. 93.5%，Log-Rankχ²=0.675，P＞0.05）；观察组患者累积无复发转移生存率高于对照组，差异具有统计学意义（90.3% vs. 64.5%，Log-Rankχ²=5.453，P＜0.05）。

结论

针对进展期右半结肠癌患者，实施CME+D3根治术时，以肠系膜上动脉（SMA）左缘作为淋巴结清扫的内侧界限，可提高淋巴结清扫质量，对提高患者预后有积极意义。

Objective

To explore the clinical effect of complete mesocolic excision （CME） plus D3 radical resection with the superior mesenteric artery （SMA） as the medial boundary in patients with advanced colon cancer.

Methods

A total of 62 patients with advanced right-sided colon cancer who underwent CME plus D3 radical resection from January 2020 to December 2023 were selected as the research objects.They were divided into the control group （n=31 cases） and the observation group （n=31 cases） by the random number table method.In the control group，the left edge of the superior mesenteric vein （SMV） was taken as the medial boundary of lymph node dissection，while in the observation group，the left edge of the superior mesenteric artery（SMA） was taken as the medial boundary of lymph node dissection.The statistical software SPSS 27.0 was used for data analysis.Measurement data such as perioperative indexes and postoperative pathological conditions were expressed as （±s），and independent samples t test was performed.The incidence of postoperative complications was expressed as a rate，and the chi-square test was used for comparison between groups.A P value less than 0.05 was considered statistically significant.

Results

There were no statistically significant differences in operation time，intraoperative blood loss，ventilation time，length of hospital stay，tumor diameter，and degree of tumor differentiation between the two groups （P＞0.05）.The drainage tube placement time in the observation group was longer than that in the control group，and the postoperative drainage volume，the number of positive lymph nodes，and the total number of dissected lymph nodes were all more than those in the control group （P＜0.05）.There was no statistically significant difference in the total incidence of postoperative complications between the control group and the observation group （19.4% vs. 6.5%，P＞0.05）.After a 2-year follow-up，there was no statistically significant difference in the cumulative overall survival rate between the two groups （87.1% vs. 93.5%，Log-Rankχ²=0.675，P＞0.05）.The cumulative recurrence-free and metastasisfree survival rate in the observation group was higher than that in the control group，and the difference was statistically significant （90.3% vs. 64.5%，Log-Rankχ²=5.453，P＜0.05）.

Conclusion

For patients with advanced right-sided colon cancer，when performing CME plus D3 radical resection，taking the left edge of the superior mesenteric artery （SMA） as the medial boundary of lymph node dissection can improve the quality of lymph node dissection，which is of positive significance for improving the prognosis of patients.