腹腔鏡結直腸癌根治術與同期開腹手術對比的單中心回顧性研究_《中國普外基礎與臨床雜志》

作者：

范瑩 , 吳碩東 , 于宏 , 蘇洋 , 孔靜 , 田雨

中國醫科大學附屬盛京醫院第一微創外科膽道外科(沈陽 110004);

關鍵詞：

結腸癌直腸癌腹腔鏡手術

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目的回顧性分析比較腹腔鏡結直腸癌根治術與同期開腹手術患者的臨床資料，探討應用腹腔鏡技術行結直腸癌根治術的可行性。方法 2001年8月至2008年6月期間我科行腹腔鏡結直腸癌根治術患者62例（腹腔鏡組），其中右半結腸癌根治術17例，橫結腸癌根治術2例，左半結腸癌根治術10例，直腸癌Dixon手術23例、Miles手術9例、Hartmann手術1例；開腹結直腸癌根治術患者78例（開腹組），其中右半結腸癌根治術17例，橫結腸癌根治術4例，左半結腸癌根治術11例，直腸癌Dixon手術27例、Miles手術18例、Hartmann手術1例，對照比較2組患者的手術及術后情況。結果 2組均無術中、術后嚴重并發癥和手術死亡病例，腹腔鏡組有4例中轉開腹手術。腹腔鏡組與開腹組的平均手術時間分別為（230.6±23.5） min和（145.5±17.6） min，差異有統計學意義(P＜0.01)。腹腔鏡組術中失血量明顯少于開腹組〔(135.5±22.5) ml 比（300.6±34.5） ml，P＜0.01〕。清除的淋巴結數量2組間差異無統計學意義〔(11.8±1.5)枚比（13.3±1.7）枚，P gt;0.05〕。直腸前切除遠端切緣長度腹腔鏡組明顯長于開腹組〔（3.1±0.4） cm 比(2.6±0.3) cm，P＜0.01〕。腹腔鏡組術后胃腸功能和排尿功能恢復時間明顯早于開腹組〔進流質飲食時間: (2.3±0.7) d比(3.6±0.9) d，P＜0.05；進固體飲食時間: (3.5±1.1) d比(4.7±1.2) d，P＜0.05；留置導尿管時間: (2.3±0.4) d比(4.4±1.2) d，P＜0.01〕。腹腔鏡組住院時間明顯短于開腹組〔(8.5±0.7) d比（12.8±0.9） d，P＜0.01〕，但住院費用仍明顯高于開腹組〔(3.14±0.25)×104元比（2.02±0.75）×104元，P＜0.05〕。2組的3年生存率差異無統計學意義(89.5%比89.1%，P gt;0.05)。結論腹腔鏡結直腸癌切除術安全、有效，具有可行性。

引用本文： 范瑩,吳碩東,于宏,蘇洋,孔靜,田雨. 腹腔鏡結直腸癌根治術與同期開腹手術對比的單中心回顧性研究. 中國普外基礎與臨床雜志, 2009, 16(5): 384-388. doi: 復制

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12.	Mirza MS, Longman RJ, Farrokhyar F， et al. Long-term outcomes for laparoscopic versus open resection of nonmetastatic colorectal cancer [Ｊ]. J Laparoendosc Adv Surg Tech A, 2008; 18(5): 679-685.
13.	Reymond MA, Wittekind C, Jung A, et al. The incidence of port-site metastases might be reduced [Ｊ]. Surg Endosc, 1997; 11(9): 902-906.
14.	Steinert R, Lippert H, Reymond MA. Tumor cell dissemination during laparoscopy: prevention and therapeutic opportunities [Ｊ]. Dig Surg, 2002; 19(6): 464-472.
15.	Jingli C, Rong C, Rubai X. Influence of colorectal laparoscopic surgery on dissemination and seeding of tumor cells [Ｊ]. Surg Endosc, 2006; 20(11): 1759-1761.
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18.	King PM, Blazeby JM, Ewings P， et al. Detailed evaluation of functional recovery following laparoscopic or open surgery for colorectal cancer within an enhanced recovery programme [Ｊ]. Int J Colorectal Dis, 2008; 23(8): 795-800.
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20.	黃石川，游志堅，梁子君，等. 腹腔鏡結直腸腫瘤手術18例報道 [Ｊ]. 中國普外基礎與臨床雜志， 2008； 15（10）：722-725.
21.	Park JS, Kang SB, Kim SW, et al. Economics and the laparoscopic surgery learning curve: comparison with open surgery for rectosigmoid cancer [Ｊ]. World J Surg, 2007; 31(9): 1827-1834.
22.	Choi YS, Lee SI, Lee TG, et al. Economic outcomes of laparoscopic versus open surgery for colorectal cancer in Korea [Ｊ]. Surg Today, 2007; 37(2): 127-132.
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25.	Kuhry E, Schwenk W, Gaupset R, et al. Long-term outcome of laparoscopic surgery for colorectal cancer: a cochrane systematic review of randomised controlled trials [Ｊ]. Cancer Treat Rev, 2008; 34(6): 498-504.
26.	Liang Y, Li G, Chen P, et al. Laparoscopic versus open colorectal resection for cancer: a meta-analysis of results of randomized controlled trials on recurrence [Ｊ]. Eur J Surg Oncol, 2008; 34(11): 1217-1224.
27.	Rosenberg J, Harvald T, Haglind E. Laparoscopic versus open total mesorectal excision for rectal cancer [Ｊ]. Ugeskr Laeger, 2007; 169(43): 3652-3655.
28.	Procacciante F, Flati D, Diamantini G, et al. Severe postoperative complications in colorectal surgery for cancer. Incidence related to the techniques employed: open versus laparoscopic colectomy [Ｊ]. Chir Ital, 2008; 60(3): 329-336.

1. Braga M, Frasson M, Vignali A, et al. Laparoscopic vs. open colectomy in cancer patients: long-term complications, quality of life, and survival [Ｊ]. Dis Colon Rectum, 2005; 48(12): 2217-2223.
2. Mehta PP, Griffin J, Ganta S， et al. Laparoscopic-assisted colon resections: long-term results and survival [Ｊ]. JSLS, 2005; 9(2): 184-188.
3. Gayet B, Cavaliere D, Castel B， et al. Laparoscopic liver surgery for metastases of colorectal cancer: analysis of a monocentric experience [Ｊ]. Suppl Tumori, 2005; 4(3): S135-S137.
4. Reza MM, Blasco JA, Andradas E, et al. Systematic review of laparoscopic versus open surgery for colorectal cancer [Ｊ]. Br J Surg, 2006; 93(8): 921-928.
5. 鄭民華, 馬君俊. 腹腔鏡外科在爭議中發展 [Ｊ]. 中國普外基礎與臨床雜志， 2007； 14(5): 503-505.
6. Veenhof AA, Engel AF, Craanen ME, et al. Laparoscopic versus open total mesorectal excision: a comparative study on short-term outcomes. A single-institution experience regarding anterior resections and abdominoperineal resections [Ｊ]. Dig Surg, 2007; 24(5): 367-374.
7. Miyajima N, Fukunaga M, Hasegawa H, et al. Results of a multicenter study of 1057 cases of rectal cancer treated by laparoscopic surgery [Ｊ]. Surg Endosc, 2009; 23(1): 113-118.
8. Franko J, Fassler SA, Rezvani M, et al. Conversion of laparoscopic colon resection does not affect survival in colon cancer [Ｊ]. Surg Endosc, 2008; 22(12): 2631-2634.
9. Veldkamp R, Kuhry E, Hop WC, et al. Laparoscopic surgery versus open surgery for colon cancer: short-term outcomes of a randomised trial [Ｊ]. Lancet Oncol, 2005; 6(7): 477-484.
10. Aziz O, Constantinides V, Tekkis PP， et al. Laparoscopic versus open surgery for rectal cancer: a meta-analysis [Ｊ]. Ann Surg Oncol, 2006; 13(3): 413-424.
11. Abraham NS, Young JM, Solomon MJ. Metaanalysis of short-term outcomes after laparoscopic resection for colorectal cancer [Ｊ]. Br J Surg, 2004; 91(9): 1111-1124.
12. Mirza MS, Longman RJ, Farrokhyar F， et al. Long-term outcomes for laparoscopic versus open resection of nonmetastatic colorectal cancer [Ｊ]. J Laparoendosc Adv Surg Tech A, 2008; 18(5): 679-685.
13. Reymond MA, Wittekind C, Jung A, et al. The incidence of port-site metastases might be reduced [Ｊ]. Surg Endosc, 1997; 11(9): 902-906.
14. Steinert R, Lippert H, Reymond MA. Tumor cell dissemination during laparoscopy: prevention and therapeutic opportunities [Ｊ]. Dig Surg, 2002; 19(6): 464-472.
15. Jingli C, Rong C, Rubai X. Influence of colorectal laparoscopic surgery on dissemination and seeding of tumor cells [Ｊ]. Surg Endosc, 2006; 20(11): 1759-1761.
16. Koopmann MC, Heise CP. Laparoscopic and minimally invasive resection of malignant colorectal disease[Ｊ]. Surg Clin North Am, 2008; 88(5): 1047-1072.
17. Buchanan GN, Malik A, Parvaiz A， et al. Laparoscopic resection for colorectal cancer [Ｊ]. Br J Surg, 2008; 95(7): 893-902.
18. King PM, Blazeby JM, Ewings P， et al. Detailed evaluation of functional recovery following laparoscopic or open surgery for colorectal cancer within an enhanced recovery programme [Ｊ]. Int J Colorectal Dis, 2008; 23(8): 795-800.
19. Laurent C, Leblanc F, Bretagnol F, et al. Long-term wound advantages of the laparoscopic approach in rectal cancer [Ｊ]. Br J Surg, 2008; 95(7): 903-908.
20. 黃石川，游志堅，梁子君，等. 腹腔鏡結直腸腫瘤手術18例報道 [Ｊ]. 中國普外基礎與臨床雜志， 2008； 15（10）：722-725.
21. Park JS, Kang SB, Kim SW, et al. Economics and the laparoscopic surgery learning curve: comparison with open surgery for rectosigmoid cancer [Ｊ]. World J Surg, 2007; 31(9): 1827-1834.
22. Choi YS, Lee SI, Lee TG, et al. Economic outcomes of laparoscopic versus open surgery for colorectal cancer in Korea [Ｊ]. Surg Today, 2007; 37(2): 127-132.
23. Colon Cancer Laparoscopic or Open Resection Study Group, Buunen M, Veldkamp R, et al. Survival after laparoscopic surgery versus open surgery for colon cancer: long-term outcome of a randomised clinical trial [Ｊ]. Lancet Oncol, 2009; 10(1): 44-52.
24. Lacy AM, García-Valdecasas JC, Delgado S, et al. Laparoscopyassisted colectomy versus open colectomy for treatment of non-metastatic colon cancer: a randomised trial [Ｊ]. Lancet, 2002; 359(9325): 2224-2229.
25. Kuhry E, Schwenk W, Gaupset R, et al. Long-term outcome of laparoscopic surgery for colorectal cancer: a cochrane systematic review of randomised controlled trials [Ｊ]. Cancer Treat Rev, 2008; 34(6): 498-504.
26. Liang Y, Li G, Chen P, et al. Laparoscopic versus open colorectal resection for cancer: a meta-analysis of results of randomized controlled trials on recurrence [Ｊ]. Eur J Surg Oncol, 2008; 34(11): 1217-1224.
27. Rosenberg J, Harvald T, Haglind E. Laparoscopic versus open total mesorectal excision for rectal cancer [Ｊ]. Ugeskr Laeger, 2007; 169(43): 3652-3655.
28. Procacciante F, Flati D, Diamantini G, et al. Severe postoperative complications in colorectal surgery for cancer. Incidence related to the techniques employed: open versus laparoscopic colectomy [Ｊ]. Chir Ital, 2008; 60(3): 329-336.

《中國普外基礎與臨床雜志》

腹腔鏡結直腸癌根治術與同期開腹手術對比的單中心回顧性研究

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《中國普外基礎與臨床雜志》

腹腔鏡結直腸癌根治術與同期開腹手術對比的單中心回顧性研究

摘要 全文 圖表 視頻 參考文獻 施引文獻 補充材料

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