中国实用外科杂志

中国实用外科杂志 ›› 2011, Vol. 31 ›› Issue (06): 494-496.

• 论著 • 上一篇    下一篇

完整结肠系膜切除在结肠癌手术治疗中的应用

叶颖江，高志冬，王    杉，尹慕军，杨晓东，梁    斌，姜可伟，董令仪   

  1. 北京大学人民医院胃肠外科，北京100044
  • 出版日期:2011-06-01 发布日期:2011-05-24

  • Online:2011-06-01 Published:2011-05-24

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摘要：

目的    探讨完整结肠系膜切除（complete mesocolic excision，CME）在结肠癌手术治疗中的应用。 方法    回顾性分析2009-11-01至2011-01-31北京大学人民医院胃肠外科同一手术治疗组31例非转移结肠癌（不合并肠梗阻）的临床资料。 结果    31例均行CME，中位淋巴结清扫数19枚，Ⅲ期病人中26.67%（4/15）的系膜根部淋巴结转移阳性。所有病人中位手术时间2.75h，术中出血量100mL，手术并发症发生率12.9%（4/31）。中位术后排气时间4d、排便时间6d、住院时间19.5d。病人出院30d内再入院率和术后30d病死率为0。 结论    CME可以达到结肠癌的根治性完整切除，达到系膜和淋巴组织切除的最大化，但并未增加手术风险，甚至术中出血量较传统根治手术有减少趋势。术后短期效果良好，不影响病人康复，但能否提高远期疗效尚待随访。

关键词: 完整结肠系膜切除, 结肠癌, 规范化手术

Abstract:

Complete mesocolic excision for colon cancer        YE Ying-jiang, GAO Zhi-dong, WANG Shan, et al. Department of Gastrointestinal Surgery, Beijing University People’s Hospital, Beijing 100044, China
Corresponding author: WANG Shan, E-mail: shwang60@sina.com
Abstract    Objective    To investigate the therapeutic effect of complete mesocolic excision (CME) for colon cancer. Methods    The data of 31 cases of colon cancer without metastasis and intestinal obstruction performed elective CME by the same group of surgeons between November 1, 2009 and January 31, 2011 at Beijing University People’s Hospital were analyzed retrospectively. Results    Among the 31 cases with CME, the median number of total lymph nodes retrieved was 19. Four (26.67%) cases of stage Ⅲ had the positive lymph nodes in or over mesenteric root. The median operation time of all cases was 2.75 hours. The volume of intraoperative blood loss was 100 mL. The overall postoperative morbidity rate was 12.9% (4/31). The median time of exhaust and defecation was 4 days and 6 days respectively. The median hospital stay was 19.5 days. The median 30-day hospital readmission and postoperative mortality was none. Conclusion    By complete mesocolic excision, the integrated radical resection for colon cancer could be completed successfully. The mesentery and lymphoid tissue could be eliminated maximally without more surgical risk.  The intraoperative blood loss of CME is less than that of traditional resection. CME could achieve good short-term outcomes and does not affect the rehabilitation. But the effect of long term should be followed up.

Key words: complete mesocolic excision, colon cancer, standardization operation