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中华结直肠疾病电子杂志

中华结直肠疾病电子杂志 ›› 2023, Vol. 12 ›› Issue (03) : 214 -220. doi: 10.3877/cma.j.issn.2095-3224.2023.03.007

论著

横结肠切除与扩大结肠切除治疗横结肠癌疗效比较
邓振汝, 林树文, 吕泽坚, 郑佳彬, 廖乾超, 冯伙伦, 吴德庆, 王俊江, 李勇†()   
  1. 523900　东莞市滨海湾中心医院普通外科；510000　广东省人民医院胃肠外科
    523900　东莞市滨海湾中心医院普通外科
    510000　广东省人民医院胃肠外科
  • 收稿日期:2022-05-10 出版日期:2023-06-25
  • 通信作者: 李勇
  • 基金资助:
    广东省自然科学基金面上项目(2020A1515010573)

Comparison of transverse colectomy and extended colectomy in the treatment of transverse colon cancer

Zhenru Deng, Shuwen Lin, Zejian Lv, Jiabin Zheng, Qianchao Liao, Huolun Feng, Deqing Wu, Junjiang Wang, Yong Li†()   

  1. Department of General Surgery, Dongguan Binhai Bay Central Hospital, Dongguan 523900, China; Department of Gastrointestinal Surgery, Guangdong Provincial People's Hospital, Guangdong 510000, China
    Department of General Surgery, Dongguan Binhai Bay Central Hospital, Dongguan 523900, China
    Department of Gastrointestinal Surgery, Guangdong Provincial People's Hospital, Guangdong 510000, China
  • Received:2022-05-10 Published:2023-06-25
  • Corresponding author: Yong Li
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引用本文：

邓振汝, 林树文, 吕泽坚, 郑佳彬, 廖乾超, 冯伙伦, 吴德庆, 王俊江, 李勇. 横结肠切除与扩大结肠切除治疗横结肠癌疗效比较[J]. 中华结直肠疾病电子杂志, 2023, 12(03): 214-220.

Zhenru Deng, Shuwen Lin, Zejian Lv, Jiabin Zheng, Qianchao Liao, Huolun Feng, Deqing Wu, Junjiang Wang, Yong Li. Comparison of transverse colectomy and extended colectomy in the treatment of transverse colon cancer[J]. Chinese Journal of Colorectal Diseases(Electronic Edition), 2023, 12(03): 214-220.

目的

比较横结肠切除与扩大结肠切除治疗横结肠癌的疗效差异，寻找合适的手术方式，为临床治疗提供参考。

方法

收集于2006年1月至2019年12月在广东省人民医院胃肠外科接受手术治疗的横结肠癌患者的临床病理资料。分析两组术式生存及临床指标差异等。

结果

共纳入366例患者，其中横结肠切除58例，扩大结肠切除308例。横结肠切除组与扩大结肠切除组的5年总生存率、5年无病生存率差异无统计学意义（均P＞0.05）；在TNM Ⅰ期、Ⅱ期、Ⅲ期患者中，横结肠切除组与扩大结肠切除组的5年总生存率差异无统计学意义（均P＞0.05）。横结肠切除组术中出血量少于扩大结肠切除组［（55.0±29.0）mL、（96.9±28.3）mL］、横结肠切除组清扫淋巴结数少于扩大结肠切除组［（19.5±8.4）枚、（23.1±11.4）枚］，差异均有统计学意义（均P＜0.05）。两组的手术时间、术后住院时间、术后出现吻合口漏、腹腔感染、伤口感染、肠梗阻、复发转移差异无统计学意义（均P＞0.05）。单因素分析结果显示，术后T分期、术后N分期、脉管癌栓侵犯、术后化疗、手术入路、肿瘤大体分型、肿瘤分化程度是影响患者预后的危险因素（均P＜0.05）。将上述单因素危险因素纳入多因素分析显示，术后T分期、术后N分期、脉管癌栓侵犯、术后化疗、手术入路、肿瘤大体分型、肿瘤分化程度均是影响患者生存预后的独立危险因素（均P＜0.05）。

结论

横结肠切除与扩大结肠切除治疗横结肠癌患者远期预后相当，横结肠切除并没有增加术后出现并发症的风险，横结肠切除可安全用于横结肠癌患者。

关键词: 结肠肿瘤, 横结肠肿瘤, 横结肠切除, 扩大结肠切除, 危险因素, 预后
Objective

To compare the curative effect of transverse colon resection and extended colon resection in the treatment of transverse colon cancer, and to find a suitable surgical method to provide reference for clinical treatment.

Methods

The clinicopathological data of patients with transverse colon cancer who received surgical treatment in the gastrointestinal surgery department of Guangdong Provincial People's Hospital from January 2006 to December 2019 were collected. Analyze the differences in surgical survival and clinical indicators between the two groups.

Results

A total of 366 patients were included, including 58 cases of transverse colon resection and 308 cases of extended colon resection. There was no significant difference in 5-year overall survival rate and 5-year disease-free survival rate between the transverse colon resection group and the extended colon resection group (all P＞0.05).There was no significant difference in the 5-year overall survival rate between the transverse colon resection group and the extended colon resection group in patients with TNM stage I, II and III (all P＞0.05).The amount of intraoperative bleeding in the transverse colon resection group was less than that in the extended colon resection group [(55.0±29.0) mL, (96.9±28.3) mL], and the number of lymph nodes cleared in the transverse colon resection group was less than that in the extended colon resection group [(19.5±8.4), (23.1±11.4)], which were statistically significant (all P＜0.05).The results of univariate analysis showed that postoperative T stage, postoperative N stage, vascular cancer thrombus invasion, postoperative chemotherapy, surgical approach, tumor gross classification, and tumor differentiation were risk factors affecting patient prognosis (all P＜0.05).The inclusion of single factor risk factors in multivariate analysis showed that postoperative T stage, postoperative N stage, vascular tumor thrombus invasion, postoperative chemotherapy, surgical approach, tumor gross classification, and tumor differentiation were all independent risk factors affecting patient survival and prognosis (all P＜0.05).

Conclusion

Transverse colectomy has the same long-term prognosis as extended colectomy in the treatment of patients with transverse colon cancer. Transverse colectomy does not increase the risk of postoperative complications. Transverse colectomy can be safely used in patients with transverse colon cancer.

Key words: Colonic neoplasms, Transverse colon cancer, Transverse colectomy, Extended colectomy, Risk factors, Prognosis
表1 两组横结肠癌患者一般资料比较
变量 横结肠切除（n=58） 扩大结肠切除（n=308） t/χ2值 P值
年龄（岁） 59.3±16.1 60.2±15.1 -0.417 0.455
性别 1.333 0.248
男 28 174
女 30 134
肿瘤直径（cm） 4.7±2.5 4.7±2.4 -0.221 0.835
手术入路 2.327 0.127
腹腔镜 37 163
开腹 21 145
术后化疗 0.151 0.698
是 19 93
否 39 215
组织学分型 2.138 0.544
腺癌 52 287
鳞癌 0 1
黏液腺癌 6 18
印戒细胞癌 0 2
大体分型 3.839 0.279
菜花型 11 72
浸润型 7 36
溃疡型 33 137
隆起型 7 63
分化程度 0.206 0.902
低分化 39 208
中分化 13 63
高分化 6 37
pT分期 7.463 0.059
T1 5 18
T2 11 35
T3 29 211
T4 13 44
pN分期 1.176 0.555
N0 29 151
N1 19 118
N2 10 39
表2 横结肠切除与扩大结肠切除患者手术与术后情况比较
变量 横结肠切除（n=58） 扩大结肠切除（n=308） t/χ2值 P值
术中出血量（mL） 55.0±29.0 96.9±28.3 7.166 0.008
淋巴结清扫数（个） 19.5±8.4 23.2±11.4 1.706 0.026
手术时间（min） 166.3±15.5 161.8±18.4 1.133 0.288
术后住院时间（天） 6.1±0.9 6.0±2.8 3.198 0.075
吻合口漏（例） 3 7 1.544 0.214
腹腔感染（例） 2 3 2.218 0.136
伤口感染（例） 4 8 2.845 0.092
肠梗阻（例） 5 13 2.021 0.155
术后复发转移（例） 0.024 0.988
局部复发 2 10
远处转移 5 25
图1 横结肠切除与扩大结肠切除总生存曲线比较
图2 横结肠切除与扩大结肠切除无病生存曲线比较
图3 Ⅰ期患者横结肠切除与扩大结肠切除总生存曲线比较
图4 Ⅱ期患者横结肠切除与扩大结肠切除总生存曲线比较
图5 Ⅲ期患者横结肠切除与扩大结肠切除总生存曲线比较
表3 影响横结肠癌患者预后的单因素分析
因素 例数 5年生存率（%） χ2值 P值
性别 2.212 0.137
男 202 77.9
女 164 76.1
年龄（岁） 0.006 0.938
≤65 221 78.3
>65 145 74.8
pT分期 26.827 <0.001
T1 23 76.3
T2 46 87.6
T3 240 76.6
T4 57 65.9
pN分期 11.633 0.003
N0 180 78.0
N1 137 74.0
N2 49 80.7
脉管癌栓侵犯 19.448 <0.001
是 108 59.1
否 258 82.0
术后化疗 6.478 0.011
是 112 85.5
否 254 73.0
近切缘长度（cm） 0.296 0.586
≤10 262 76.9
>10 104 77.2
远切缘长度（cm） 1.413 0.235
≤12 325 78.4
>12 41 66.9
手术入路 21.701 <0.001
腹腔镜 200 84.2
开腹 166 69.9
手术方式 0.142 0.706
横结肠切除 58 82.2
扩大结肠切除 308 76.2
大体分型 12.100 0.007
菜花型 83 94.8
浸润型 43 79.8
溃疡型 170 73.2
隆起型 70 62.3
分化程度 16.886 <0.001
低分化 247 74.6
中分化 76 88.1
高分化 43 90.4
表4 影响横结肠癌患者预后的多因素分析
临床病理因素 B值 标准误 Wald值 HR值 95%可信区间 P值
pT分期 0.705 0.312 5.110 2.024 1.098~3.731 0.024
pN分期 0.452 0.203 4.944 1.571 1.055~2.341 0.026
大体分型 0.788 0.218 13.016 2.198 1.433~3.372 0.001
脉管癌栓侵犯 -0.947 0.234 16.442 0.388 0.245~0.613 0.001
术后化疗 -0.709 0.224 10.040 0.492 0.318~0.763 0.002
手术入路 0.818 0.230 12.645 2.266 1.444~3.558 0.001
肿瘤分化程度 -1.494 0.430 12.076 0.224 0.097~0.521 0.001
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