本文選題：Ⅲ期結(jié)腸癌 + 完整結(jié)腸系膜切除�。� 參考：《新鄉(xiāng)醫(yī)學(xué)院》2016年碩士論文

【摘要】：背景:結(jié)腸癌是常見(jiàn)的惡性腫瘤之一,近年來(lái)其發(fā)病率不斷升高,由于國(guó)內(nèi)早期篩查力量及民眾醫(yī)療意識(shí)薄弱,多數(shù)患者發(fā)現(xiàn)時(shí)已為中晚期。傳統(tǒng)結(jié)腸癌根治術(shù)在系膜游離、血管根部結(jié)扎及淋巴結(jié)清掃上未予以重視,從而使Ⅲ期結(jié)腸癌患者術(shù)后出現(xiàn)復(fù)發(fā)與轉(zhuǎn)移者不在少數(shù)。自Hohenberger教授首次提出完整結(jié)腸系膜切除(CME)這一理念后,多數(shù)學(xué)者在其意義論述上給予肯定,但國(guó)內(nèi)CME的相關(guān)研究還不夠充分,實(shí)際操作過(guò)程中依然讓多數(shù)醫(yī)生無(wú)據(jù)可循,使得外科的手術(shù)操作不能規(guī)范。目的:回顧性分析行不同手術(shù)方式的兩組Ⅲ期結(jié)腸癌患者的病理和臨床資料,比較完整結(jié)腸系膜切除術(shù)與傳統(tǒng)結(jié)腸癌根治術(shù)在術(shù)中指標(biāo)、病理學(xué)指標(biāo)、術(shù)后恢復(fù)及復(fù)發(fā)與轉(zhuǎn)移等方面的差異,探討完整結(jié)腸系膜切除術(shù)應(yīng)用于Ⅲ期結(jié)腸癌患者的手術(shù)操作要點(diǎn)及臨床療效。方法:回顧性分析2012年1月-2014年12月武警后勤學(xué)院附屬醫(yī)院腫瘤外科及胃腸外科收治的85例Ⅲ期結(jié)腸癌患者,根據(jù)手術(shù)方式分為CME組(47例)和傳統(tǒng)組(38例)。傳統(tǒng)組實(shí)行傳統(tǒng)結(jié)腸癌根治術(shù),切除腸管的遠(yuǎn)近切緣距腫瘤至少8cm,清掃腸周及中間站淋巴結(jié),但不強(qiáng)調(diào)腸管、系膜后葉的分離層次及血管根部結(jié)扎和主淋巴結(jié)清掃。CME組采用對(duì)側(cè)站位,銳性游離系膜,血管根部高位結(jié)扎。主淋巴結(jié)則根據(jù)右半與左半結(jié)腸的不同,分別采用以Henle血管干走行為基礎(chǔ)的三方向清掃和以腸系膜下動(dòng)脈根部為中心的立體式清掃。分析對(duì)比兩組在術(shù)中指標(biāo)、病理學(xué)指標(biāo)、術(shù)后恢復(fù)、復(fù)發(fā)與轉(zhuǎn)移等方面的差異是否具有統(tǒng)計(jì)學(xué)意義。所有數(shù)據(jù)應(yīng)用SPSS16.0軟件進(jìn)行統(tǒng)計(jì)分析,計(jì)量資料采用獨(dú)立樣本t檢驗(yàn)或Mann-Whitney U檢驗(yàn);計(jì)數(shù)資料采用卡方檢驗(yàn)或Fisher精確檢驗(yàn),設(shè)P0.05為差異有統(tǒng)計(jì)學(xué)意義。結(jié)果:本實(shí)驗(yàn)結(jié)果顯示CME組淋巴結(jié)清掃總數(shù)[(20.44±7.26)枚]和陽(yáng)性淋巴數(shù)[4(2~7)枚]明顯多于傳統(tǒng)組[(16.11±5.00)枚、2(1~5)枚](P0.05),CME組手術(shù)時(shí)間[(208.00±32.93)min]、術(shù)中出血量[(154.44±68.94)m L]明顯少于傳統(tǒng)組[(223.84±18.80)min、(234.21±96.63)m L](P0.05);CME組術(shù)后排氣時(shí)間[(3.93±1.15)day]、進(jìn)食時(shí)間[(5.09±0.92)day]與傳統(tǒng)組[(4.00±1.07)day]、[(5.61±1.42)day]比較無(wú)統(tǒng)計(jì)學(xué)差異(P0.05)。CME組右半及左半結(jié)腸的腸系膜切除面積[165.3(112.7,196.8)、134.4(130.4,187.5)cm2]、腫瘤至血管高位結(jié)扎點(diǎn)最短距離[13.8(9.8,15.4)、14.6(10.4,16.8)cm]、腸壁至血管高位結(jié)扎點(diǎn)最短距離[11.3(8.6,12.8)、10.7(8.4,12.3)cm]明顯多于傳統(tǒng)組的[116.2(75.6,136.2)、95.3(82.8,135.3)cm2]、[10.7(8.1,13.2)、11.8(8.9,13.8)cm]和[8.2(7.1,11.5)、9.3(7.9,10.4)cm],二者比較有統(tǒng)計(jì)學(xué)意義(P0.05)。CME組術(shù)后并發(fā)癥發(fā)生率(17.02%)與傳統(tǒng)組(15.79%)比較無(wú)統(tǒng)計(jì)學(xué)差異(P0.05)。CME組術(shù)后復(fù)發(fā)轉(zhuǎn)移1例(2.13%),傳統(tǒng)組術(shù)后復(fù)發(fā)轉(zhuǎn)移4例(10.53%)差異有統(tǒng)計(jì)學(xué)意義(P0.05)。結(jié)論:1.Ⅲ期結(jié)腸癌患者行完整結(jié)腸系膜切除術(shù)與行傳統(tǒng)結(jié)腸癌根治術(shù)相比,在淋巴結(jié)清掃總數(shù)、陽(yáng)性淋巴結(jié)清掃數(shù)、手術(shù)時(shí)間、術(shù)中出血量、腸系膜切除面積、腫瘤至血管高位結(jié)扎點(diǎn)最短距離、腸壁至血管高位結(jié)扎點(diǎn)最短距離及術(shù)后復(fù)發(fā)轉(zhuǎn)移率等方面占有優(yōu)勢(shì),故Ⅲ期結(jié)腸癌患者應(yīng)用完整結(jié)腸系膜切除優(yōu)于傳統(tǒng)手術(shù)方式。2.行完整結(jié)腸系膜切除術(shù)時(shí),術(shù)者采用對(duì)側(cè)站位,操作過(guò)程中左手牽拉組織保持張力,右手行系膜銳性游離,利于保證Toldt筋膜剝離的完整性,能增加操作的便利性,可操作性強(qiáng)。3.完整結(jié)腸系膜切除術(shù)在右半及左半結(jié)腸的主淋巴結(jié)清掃分別采用沿Henle血管干三個(gè)走行方向清掃及以腸系膜下動(dòng)根部為中心的立體式清掃方式,能增加淋巴結(jié)清掃數(shù)量,減少腫瘤殘留,降低患者術(shù)后復(fù)發(fā)轉(zhuǎn)移率。
[Abstract]:Background: colon cancer is one of the most common malignant tumors. In recent years, the incidence of cancer is increasing. Most patients have been found in the middle and late stages because of the early screening force in China and the weak awareness of the people's medical treatment. Most scholars have given the concept of complete colon mesangial excision (CME) for the first time since Hohenberger. Most scholars have given affirmation in their significance, but the relevant research in domestic CME is not enough. In the actual operation, many doctors still have no evidence to follow. Objective: To review and analyze the pathological and clinical data of two groups of stage III colon cancer patients with different surgical methods, and compare the differences of complete colectomy and traditional colon cancer radical operation in the intraoperative index, pathological index, postoperative recovery and recurrence and metastasis, and discuss the application of complete colectomy in stage III of the colon. Surgical operation points and clinical efficacy of colon cancer patients. Methods: retrospective analysis of 85 patients with stage III colon cancer admitted in the cancer surgery and gastrointestinal surgery department of the Affiliated Hospital of armed police Logistics Institute in December -2014 January 2012, divided into group CME (47 cases) and traditional group (38 cases) according to the operation method. Traditional group performed radical resection of colon cancer, resection of intestine The distant adjacent margin of the tube was at least 8cm, dissection of the pericenteric and intermediate lymph nodes, but did not emphasize the intestinal canal, the separation level of the posterior mesangial lobe, the ligature of the roots of the blood vessel and the main lymph node dissection in the.CME group, the opposite position, the sharp free mesangial and the high ligation of the vascular roots. The main lymph nodes were used in Hen respectively according to the difference between the right and the left semicolons. The three direction cleaning and the stereoscopic scan with the base of the inferior mesenteric artery as the basis of the behavior of Le blood vessels. The analysis and comparison of the differences between the two groups in the intraoperative indexes, pathological indexes, postoperative recovery, recurrence and metastasis were statistically significant. All data were statistically analyzed with SPSS16.0 software, and the measurement data adopted the only one. T test of vertical samples or Mann-Whitney U test; counting data using chi square test or Fisher accurate test, P0.05 was statistically significant. Results: the results of this experiment showed that the total number of lymph node dissection in CME Group [(20.44 + 7.26)] and positive lymph nodes [4 (2~7)) were significantly more than that of the traditional group [(16.11 + 5), 2 (1~5)] (P0.05), CME group operation Time [(208 + 32.93) min]), the amount of intraoperative bleeding [(154.44 + 68.94) m L] was significantly less than that of the traditional group [(223.84 + 18.80) min, (234.21 + 96.63) m L] (P0.05); after CME group, the exhaust time [(3.93 + 1.15) day], feeding time [(5.09 + 0.92) day]] was compared with the traditional group [(4 +]) day]. The mesenteric resection area of the colon was [165.3 (112.7196.8), 134.4 (130.4187.5) cm2], the shortest distance from the tumor to the high ligation point of the vessel was [13.8 (9.8,15.4), 14.6 (10.4,16.8) cm], and the shortest distance between the intestinal wall and the high ligation point of the blood vessel was [11.3 (8.6,12.8), and 10.7 (8.4,12.3) cm] was more than that of the traditional group (8). 8 .1,13.2), 11.8 (8.9,13.8) cm] and [8.2 (7.1,11.5), 9.3 (7.9,10.4) cm], two were statistically significant (P0.05) the incidence of postoperative complications in the group.CME (17.02%) compared with the traditional group (15.79%), there was no statistical difference (P0.05).CME group postoperative recurrence and metastasis 1 cases (2.13%), traditional group postoperative recurrence and metastasis 4 cases (10.53%) difference was statistically significant (P0.05). The total number of lymph node dissection, the number of positive lymph nodes, the time of operation, the amount of bleeding, the area of mesentery resection, the shortest distance from the tumor to the high ligation point, the shortest distance to the high ligation point of the intestinal wall to the high ligation of the vessel and the recurrence after operation, compared with the traditional radical colectomy for colon cancer in 1. stage colon cancer patients. When the total colectomy in stage III colon cancer patients is superior to the complete colon mesangial excision, it is superior to the traditional surgical mode.2. for complete colectomy. The patients adopt the contralateral position, keep the tension of the left hand pull tissue during the operation, the right hand line of the mesangial membrane and the integrity of the Toldt fascia, and increase the operation. Convenient and operable.3. complete colectomy in the main lymph node dissection of the right and left semicolons in the right and left semicolons to clear the three walking directions along the Henle vascular trunk and take the inferior mesenteric root as the center, which can increase the number of lymph node dissection, reduce the residual tumor and reduce the recurrence and metastasis of the patients after operation. Rate.
【學(xué)位授予單位】：新鄉(xiāng)醫(yī)學(xué)院
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2016
【分類號(hào)】：R735.35

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