【摘要】 目的 探讨腹腔镜全结肠系膜切除(CME)手术与开腹CME手术在根治性右半结肠癌中的近期和远期疗效差异。方法 选取本院2017年1月—2018年8月收治的右半结肠癌患者84例,采用随机数字表法分为微创组(42例)和开腹组(42例)。微创组给予腹腔镜CME手术治疗,开腹组给予开腹CME手术治疗,比较2组患者手术相关指标(术中出血量、手术时间、淋巴结清扫数量、术后进食时间、术后排气时间)、应激反应相关指标[促肾上腺皮质激素(ACTH)、皮质醇(COR)、肾上腺素(E)]、术后并发症、术后生存率及复发率、术后生活质量。结果 微创组术后进食时间、术后排气时间短于开腹组,术中出血量均少于开腹组,差异有统计学意义(P<0.05)。术后,2组患者ACTH、COR、E水平升高,但微创组低于开腹组,差异均有统计学意义(P<0.05)。微创组术后并发症发生率为4.76%,低于开腹组的23.81%,差异有统计学意义(P<0.05)。微创组术后1年生存率、3年生存率及3年复发率分别为97.62%、83.33%、19.05%,开腹组1年生存率、3年生存率及3年复发率分别为95.24%、80.95%、21.43%,组间差异无统计学意义(P>0.05)。术后6个月及术后12个月,2组患者生活质量评分升高,且微创组高于开腹组,差异均有统计学意义(P<0.05)。结论 腹腔镜下CME手术与开腹CME手术远期预后均较好,但腹腔镜下CME术后应激反应轻,恢复快,且并发症少,可优先选择。更多还原

【Abstract】 Objective To explore the differences in short-term and long-term efficacy between laparoscopic complete mesocolic excision(CME) surgery and open CME surgery in the radical treatment of right hemicolectomy for colon cancer. Methods Eighty-four patients with right hemicolectomy for colon cancer in our hospital from January 2017 to August 2018 were selected and randomly assigned to the minimally invasive group(42 cases) and the open group(42 cases) using a random number table method. The minimally invasive group underwent laparoscopic CME surgery, while the open group underwent open CME surgery. Surgical-related indicators(intraoperative blood loss, time of operation, number of lymph nodes harvested, time to postoperative first eating, time to first postoperative flatus), stress response-related indicators(adrenocorticotropic hormone [ACTH], cortisol [COR], adrenaline [E]), postoperative complications, postoperative survival rate, recurrence rate, and postoperative quality of life were compared between the two groups. Results The time to postoperative first eating and time to first postoperative flatus in the minimally invasive group were shorter than those in the open group, and the intraoperative blood loss was less in the minimally invasive group than in the open group, with statistically significant differences(P<0.05). After surgery, the levels of ACTH, COR, and E in both groups increased, but were significantly lower in the minimally invasive group than in the open group(P<0.05). The incidence of postoperative complications in the minimally invasive group was significantly lower than that in the open group(4.76%, vs. 23.81%; P<0.05). The 1-year survival rate, 3-year survival rate, and 3-year recurrence rate after surgery were 97.62%, 83.33%, and 19.05%, respectively, in the minimally invasive group, and 95.24%, 80.95%, and 21.43%, respectively, in the open group, with no statistically significant differences between the groups(P>0.05). At 6 and 12 months postoperatively, the quality of life scores of patients in both groups increased, with the minimally invasive group scoring significantly higher than the open group(P <0.05). Conclusion Laparoscopic CME surgery and open CME surgery both have good long-term prognosis, but laparoscopic CME surgery generates milder stress response, faster recovery, and fewer complications, and thus may be preferred.更多还原