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目的:评估不同操作步骤的结肠癌根治手术对远期疗效的影响。对象与方法:将1981年1月至1996年12月收治的249例右侧结肠癌患者随机分成两组:一组手术从游离大网膜开始,在横结肠系膜根部上缘和胰腺下缘处分离出结肠右血管,在其根部结扎断离并清除血管根部淋巴结,最后游离肿瘤肠段(简称A组);另一组则直接分离出肿瘤肠段,沿系膜至结肠右血管根部予以结扎断离,清除血管根部淋巴结,再游离大网膜(简称B组)。249例患者中,A组98例,B组151例。结果:两组病例在肿瘤大体类型、组织学分类、恶性程度和肿瘤分期上均无统计学差异。A组术后一年内无复发,3年复发11例(11.22％),5年生存率为81.20％±3.67％;B组术后一年内复发18例(11.92％),3年复发38例(25.17％),5年生存率为64.76％±2.92％,两组相比差异显著(P<0.05)。结论:手术操作步骤在癌肿根治性切除术中占有重要地位,A组手术操作技术能明显提高生存率,降低复发率,值得推广应用。
OBJECTIVE: To assess the effect of radical surgery for colon cancer on long-term outcomes at different procedures. OBJECTIVES AND METHODS: 249 patients with right colon cancer who were admitted from January 1981 to December 1996 were randomized into two groups: one group started with free omentum, and was located at the upper edge of the transverse mesocolon and the lower edge of the pancreas. The right colonic blood vessels were isolated, and the roots were ligated to isolate and remove the root lymph nodes of the blood vessels. Finally, the free tumor segment (abbreviated as group A) was isolated; the other group was directly isolated from the tumor intestine and ligated along the mesangium to the right colonic root of the colon. Dissociate, remove lymph nodes in the roots of the blood vessels, and then free the omentum (referred to as group B). Of the 249 patients, 98 were in group A and 151 in group B. Results: There was no statistical difference in the general tumor type, histological classification, malignancy and tumor stage between the two groups. In group A, there was no recurrence within one year after surgery. 11 cases (11.22%) recurred in 3 years and the 5-year survival rate was 81.20% ± 3.67%. In group B, 18 cases (11.92%) recurred within one year and 38 cases recurred in 3 years ( 25.17%). The 5-year survival rate was 64.76% ± 2.92%. There was a significant difference between the two groups (P < 0.05). Conclusion: The operation procedure plays an important role in radical resection of cancer. The surgical operation technique of group A can significantly improve the survival rate and reduce the recurrence rate. It is worthy of popularization and application.