完整结肠系膜切除在结肠癌手术治疗中的应用_叶颖江

论著

文章编号：1005-2208（2011）06-0494-03

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

【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

中图分类号：R6文献标志码：A

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,Beijing100044,China

Corresponding author:WANG Shan,E-mail:shwang60@

Abstract Objective To investigate the therapeutic effect of complete mesocolic excision(CME)for colon cancer.

Methods The data of31cases of colon cancer without metastasis and intestinal obstruction performed elective CME by the same group of surgeons between November1,2009and January31,2011at Beijing University People’s Hospital were analyzed retrospectively.Results Among the31cases with CME,the median number of total lymph nodes retrieved was19.Four(26.67%)cases of stageⅢhad the positive lymph nodes in or over mesenteric root.The median operation time of all cases was2.75hours.The volume of intraoperative blood loss was100mL.The overall postoperative morbidity rate was12.9%(4/31).The median time of exhaust and defecation was4days and6days respectively.The median hospital stay was19.5days.The median30-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.

Keywords complete mesocolic excision;colon cancer;standardization operation

完整结肠系膜切除（complete mesocolic excision，CME）作为结肠癌规范化手术的理念最早由德国Hohenberger于2009年提出，它遵循胚胎发育解剖层面，理论依据充分可行，试图将全直肠系膜切除（TME）在直肠癌治疗的优势继承下来。符合高质量手术的目标，CME手术不仅要求肿瘤整块完整切除，还可以达到清扫最多淋巴结及淋巴管的目的。本文通过回顾性分析，探讨结肠癌病人行CME手术的安全性及短期手术效果。

1资料与方法

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诊治31例结肠癌的资料。共31例病人纳入研究，其中男14例，女17例。年龄26~90岁，平均69.5岁。肿瘤长径2.0~10.5cm。约64.5%（20/31）的病人合并内科疾病，如高血压病51.6%（16/31），冠心病25.8%（8/31），糖尿病12.9%（4/31），肺功能障碍9.7%（3/31）等。病人纳入标准：（1）经多学科专家组评估确诊为结肠癌并行术前临床分期（DICC分期）的病人；（2）首次接受手术治疗；（3）接受完整结肠系膜切除（CME）。排除标准为：（1）合并肠梗阻；（2）急诊手术；（3）有术前新辅助放化疗

作者单位：北京大学人民医院胃肠外科，北京100044通讯作者：王杉，E-mail：shwang60@