腹腔镜辅助完整结肠系膜切除术与传统开腹术后并发症分析
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摘要
目的:探讨开腹完整结肠系膜切除术与腹腔镜辅助完整结肠系膜切除术两种术式的并发症风险及Clavien-Dindo分级。方法:回顾性分析136例结肠癌患者的临床资料,根据手术方式分为开腹组和腹腔镜组,每组68例患者,比较两组术后并发症的差异。结果:开腹组术后并发症发生率23.5%(16/68),腹腔镜组16.1%(11/68,P> 0.05);两组心血管、肺部及腹部并发症均无显著性差异(P> 0.05);Ⅰ、Ⅰ、Ⅲ期结肠癌患者术后并发症无显著性差异(P> 0.05);左半结肠癌与右半结肠癌术后并发症无显著性差异(P> 0.05)。术后并发症Clavien-Dindo分级,开腹组Ⅰ级2例,Ⅰ级10例,Ⅲa级0例,Ⅲb级1例,Ⅳa级1例,Ⅳb级0例,Ⅴ级0例;腹腔镜组Ⅰ级1例,Ⅰ级11例,Ⅲa级0例,Ⅲb级1例,Ⅳa级0例,Ⅳb级0例,Ⅴ级0例,均无显著性差异(P> 0.05)。结论:与开腹完整结肠系膜切除术相比,腹腔镜辅助完整结肠系膜切除术术后并发症风险未见明显差异,具有安全性。
Objective To investigate the risk of postoperative complications and Clavien-Dindo classification in the laparoscopy-assisted complete mesocolic excision and traditional operation. Methods Clinical data of 136 patients with colon cancer from Cangzhou Hospital of Integrated Traditional Chinese and Western Medicine of Hebei Province were analyzed. The patients were divided into laparoscopy group and traditional operation group according to the different modus operandi. Each group included 68 patients. The differences of the postoperative complications between the two groups were compared. Results There were no significant differences in the incidence of postoperative complications between the two groups. Data showed laparoscopyassisted complete mesocolic excision group16.1%(11/68) and traditional operation group23.5%(16/68)(P >0.05). Postoperative complications such as cardiovascular complications, pulmonary complications, abdominal complication, were no significant differences(P>0.05).There were no obvious differences in Ⅰ、Ⅱ 、Ⅲ stage colon cancer patients(P>0.05), the same results between the left-hemi colon cancer and the right-hemi colon cancer(P>0.05).Clavien-Dindo grading situation was distinguished as following: laparoscopy group included 1 case in grade Ⅰ, 11 cases in grade Ⅱ, zero in grade Ⅲa, 1 case in grade Ⅲb, zero in grade Ⅳa, Ⅳb andⅤ. Traditional operation group included 2 cases in grade Ⅰ, 10 cases in grade Ⅱ,zero in grade Ⅲa, 1 case in grade Ⅲb, 1 case in grade Ⅳa, zero in grade Ⅳb andⅤ. Conclusion Compared with trational operation, the laparoscopyassisted complete mesocolic excision showed feasible and safety, moreover, merely differences in the risk of postoperative complications.
Objective To investigate the risk of postoperative complications and Clavien-Dindo classification in the laparoscopy-assisted complete mesocolic excision and traditional operation. Methods Clinical data of 136 patients with colon cancer from Cangzhou Hospital of Integrated Traditional Chinese and Western Medicine of Hebei Province were analyzed. The patients were divided into laparoscopy group and traditional operation group according to the different modus operandi. Each group included 68 patients. The differences of the postoperative complications between the two groups were compared. Results There were no significant differences in the incidence of postoperative complications between the two groups. Data showed laparoscopyassisted complete mesocolic excision group16.1%(11/68) and traditional operation group23.5%(16/68)(P >0.05). Postoperative complications such as cardiovascular complications, pulmonary complications, abdominal complication, were no significant differences(P>0.05).There were no obvious differences in Ⅰ、Ⅱ 、Ⅲ stage colon cancer patients(P>0.05), the same results between the left-hemi colon cancer and the right-hemi colon cancer(P>0.05).Clavien-Dindo grading situation was distinguished as following: laparoscopy group included 1 case in grade Ⅰ, 11 cases in grade Ⅱ, zero in grade Ⅲa, 1 case in grade Ⅲb, zero in grade Ⅳa, Ⅳb andⅤ. Traditional operation group included 2 cases in grade Ⅰ, 10 cases in grade Ⅱ,zero in grade Ⅲa, 1 case in grade Ⅲb, 1 case in grade Ⅳa, zero in grade Ⅳb andⅤ. Conclusion Compared with trational operation, the laparoscopyassisted complete mesocolic excision showed feasible and safety, moreover, merely differences in the risk of postoperative complications.
引文
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[11]Adamina M,Manwaring ML,Park KJ,et al.Laparoscopic complete mesocolic excision for right colon cancer[J].Surg Endosc,2012,26(10):2976-2980.
[12]Feng B,Sun J,Ling TL,et al.Laparoscopic complete mesocolic excision(CME)with medial access for right-hemi colon cancer:feasibility and technical strategies[J].Surg Endosc,2012,26(12):3669-3675.
[13]孙艳武,池畔,林惠铭,等.结肠癌完整结肠系膜切除术后乳糜瘘的影响因素分析[J].中华胃肠外科杂志,2012,15(4):328-331.
[14]Clavien PA,Barkun J,Dc Oliveira ML,et al.The Clavien-Dindo classification of surgical complication:five-year experience[J].Ann Surg,2009,250(2):187-96.
[2]Hohenberger W,Weber K,Matzel K,et al.Standardized surgery for colonic cancer:complete mesocolic excision and cen D3 al ligation-technical notes and outcome[J].Colorectal Dis,2009,11(4):354-364.
[3]Clinical Outcome of Surgical Therapy Study Group.A comparison of laparoscopically assisted and open colectomy for colon cancer[J].N Engl J Med,2004,350(20):2050-2059.
[4]叶颖江,高志冬,王杉,等.完整结肠系膜切除在结肠癌手术治疗中的应用[J].中国实用外科杂志,2011,31(6):494-496.
[5]孙艳武,池畔,林惠铭,等.腹腔镜与开腹完整结肠系膜切除术的疗效比较[J].中华胃肠外科杂志,2012,15(1):24-27.
[6]王铁,叶颖江,韩亚妹,等.完整结肠系膜切除术与传统结肠癌根治术短期疗效的比较[J].中华胃肠外科杂志,2013,16(3):264-267.
[7]Bertelsen CA,Bols B.Can the quality of colonic surgery be improved by standardization of surgical technique with complete mesocolic excision[J]?Colorectal Dis,2011 Oct;13(10):1123-1129.
[8]Dindo D,Demartines N,Clavien PA:Classifi-cation of Surgical Complications.A New Proposal With Evaluation in a Cohort of 6366 Patients and Results of a Survey[J].Ann Surg,2004,240(2):205-213.
[9]Jung MR,Park YK,Seon JW,et al.Definition and classification of complication of gastrectomy for gastric cancer based on the accordion severity grading system[J].World J Surg,2012,36(10):2400-2411.
[10]West NP,Morris EJ,Rotimi O,et al.Pathology grading of colon cancer surgical resection and its association with survival:a retrospective retrospective observational study[J].Lancet Oncol,2008,9(9):857-865.
[11]Adamina M,Manwaring ML,Park KJ,et al.Laparoscopic complete mesocolic excision for right colon cancer[J].Surg Endosc,2012,26(10):2976-2980.
[12]Feng B,Sun J,Ling TL,et al.Laparoscopic complete mesocolic excision(CME)with medial access for right-hemi colon cancer:feasibility and technical strategies[J].Surg Endosc,2012,26(12):3669-3675.
[13]孙艳武,池畔,林惠铭,等.结肠癌完整结肠系膜切除术后乳糜瘘的影响因素分析[J].中华胃肠外科杂志,2012,15(4):328-331.
[14]Clavien PA,Barkun J,Dc Oliveira ML,et al.The Clavien-Dindo classification of surgical complication:five-year experience[J].Ann Surg,2009,250(2):187-96.