【摘要】 目的:结直肠癌同时性肝转移(synchronous colorectal liver metastases,s CRLM)同期切除时,切口是外科医生需要考虑的技术问题。本研究旨在探讨切口对同期切除近期预后的影响。方法:回顾性分析2009年1月至2014年12月北京大学肿瘤医院肝胆胰外Ⅱ科37例同期切除的s CRLM患者的临床数据。结果:Mercedes切口(Mer)组19例,正中切口(Mid)组18例。2组间患者一般情况、大体积肝切除比例、手术时间、术中出血量、术中第一肝门阻断时间无显著性差异。正中切口组中直肠患者更多(P<0.001)。2组共发生并发症11例(32.4%),其中Mer组9例(47.4%),Mid组3例(16.7%),两组比较无显著性差异(P=0.08)。术后住院时间Mer组(22.1±9.5)d,Mid组(17.2±6.7)d,两组比较无显著性差异(P=0.08)。当患者BMI(body mass index)<25时,并发症Mer组5例(38.5%),Mid组0例(0%),两组比较有显著性差异(P=0.046)。术后住院时间Mer组(22.1±10.5)d,Mid组(15.7±5.3)d,P=0.051。结论:s CRLM患者进行同期切除时,正中切口可以满足术野暴露要求,相比Mercedes切口,对直肠术野的暴露更有优势;当BMI<25时,正中切口可能会有更好的近期预后。更多还原

【Abstract】 Objective: To discuss the role of incision for short-term outcomes of simultaneous resection in synchronous colorectal liver metastases(s CRLM). Methods: We reviewed the data of 37 patients who underwent simultaneous resection between January2009 and December 2014 in our department and compared the short-term outcomes between Mercedes and midline incisions. Results:Mercedes and midline incisions were used in 19 and 18 patients, respectively. The two groups showed similarities in patient characteristics, major hepatectomy, surgery time, blood loss, and hilar block time. The midline group comprised more rectal cancer patients(P<0.001). The two groups did not differ significantly in complication incidence(47.4% vs. 16.7 %, P=0.08) and postoperative stay time(22.1 ± 9.5 d vs. 17.2 ± 6.7 d, P=0.08). At body mass index(BMI) <25, the complication incidence(P=0.046) and postoperative stay time(P=0.051) were lower in the midline group than in the Mercedes group. Conclusion: Midline incision provided similar exposure in simultaneous resection for s CRLM and was better than Mercedes incision in rectal cancer patients. Patients with midline incision may attain better short-term outcomes if BMI is<25.更多还原