横结肠切除与扩大结肠切除治疗横结肠癌疗效比较

doi:10.3877/cma.j.issn.2095-3224.2023.03.007

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^†(

)

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^†()

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/OL]. 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/OL]. 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

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

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

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