中国普外基础与临床杂志

中国普外基础与临床杂志

腹腔镜全直肠系膜切除术治疗中低位直肠癌的疗效研究

查看全文

目的 探讨腹腔镜全直肠系膜切除术治疗中低位直肠癌在地市级医院开展的安全性及近期疗效。 方法 回顾性收集 2015 年 1 月至 2017 年 6 月期间于资阳市第一人民医院行腹腔镜(49 例)和开腹(45 例)直肠全系膜切除术(TME)的 94 例中低位直肠癌患者的临床病理学资料。 结果 腹腔镜组患者中转开腹 2 例,中转开腹率为 4.08%。与开腹组比较,腹腔镜组患者的术中出血量、切口长度、术后排气时间、进食流质饮食时间及术后 30 d 总并发症发生率均较短或较低(P<0.05),手术时间较长(P=0.848);而 2 组患者的术后住院时间、手术切除标本的长度、清扫的淋巴结数目及肿瘤距远切缘距离比较差异均无统计学意义(P>0.05)。 结论 腹腔镜 TME 治疗中低位直肠能达到与开腹手术相似的肿瘤根治效果,且腹腔镜手术的创伤更小、恢复更快,在地市级医院用于中低位直肠癌的治疗安全可行

Objective To evaluate the safety and short-term outcome of laparoscopic total mesorectal excision (TME) for the middle-lower rectal cancer in municipal hospital. Methods The pathological data of 94 patients with middle-lower rectal cancer (49 cases underwent laparoscopic TME, while 45 cases received open TME), who treated in The first People’s Hospital of Ziyang from Jan.2015 to Jun.2017, were retrospectively collected and analyzed. Results Two patients (4.08%) in laparoscopy group were converted to open surgery. Compare with the laparotomy group, the laparoscopic group had significantly less volume of intraoperative bleeding, shorter abdominal incision, earlier time to the first flatus and liquid diet, lower rates of 30-day postoperative complications (P<0.05), but had longer operating time (P=0.848). While there was no significant difference on postoperative stay, the specimen length, distal margin, and number of harvested lymph nodes between the 2 groups (P>0.05). Conclusions Laparoscopic TME is a feasible, safe, and minimally invasive technique for middle-lower rectal cancer, and produced more favourable short-term outcome than open surgery in municipal hospital.

关键词: 中低位直肠癌; 腹腔镜; 全直肠系膜切除术; 近期疗效

Key words: laparoscopy; middle-lower rectal cancer; total mesorectal excision; short-term outcome

登录后 ,请手动点击刷新查看全文内容。 没有账号,
登录后 ,请手动点击刷新查看图表内容。 没有账号,
1. 郑民华. 不断提高腹腔镜直肠癌外科规范化治疗水平. 中华普外科手术学杂志: 电子版, 2013, 7(2): 81-84.
2. 周总光. 腹腔镜直肠癌根治应关注的若干问题. 中华普外科手术学杂志: 电子版, 2013, 7(2): 85-87.
3. 郑民华. 我国腹腔镜结直肠外科的发展. 腹腔镜外科杂志, 2010, 15(6): 401-403.
4. 邓祥兵, 孟文建, 张元川, 等. 直肠前间隙Denovilliers筋膜分层结构及与前列腺血管分支的关系. 中华胃肠外科杂志, 2013, 16(5): 489-493.
5. 郑民华, 胡艳艳, 陆爱国, 等. 腹腔镜与开腹直肠全系膜切除术治疗低位直肠癌的临床对比研究. 中华胃肠外科杂志, 2004, 7(3): 177-180.
6. 余江, 张策, 王亚楠, 等. 腹腔镜与开腹全直肠系膜切除术治疗中低位直肠癌的同期临床对照研究. 中华胃肠外科杂志, 2009, 12(6): 573-576.
7. Hida K, Okamura R, Sakai Y, et al. Open versus laparoscopic surgery for advanced low rectal cancer: a large, multicenter, propensity score matched cohort study in Japan. Ann Surg, 2018, 268(2): 318-324.
8. 王永鹏, 佟昕, 张庆彤, 等. 腹腔镜直肠癌前切除术中转开腹影响因素的多因素分析. 中国微创外科杂志, 2016, 16(8): 694-697, 719.
9. 付涛, 刘宝华. 腹腔镜直肠切除术. 临床外科杂志, 2014, 22(4): 234-236.
10. Lujan J, Valero G, Biondo S, et al. Laparoscopic versus open surgery for rectal cancer: results of a prospective multicentre analysis of 4, 970 patients. Surg Endosc, 2013, 27(1): 295-302.
11. Boutros M, Hippalgaonkar N, Silva E, et al. Laparoscopic resection of rectal cancer results in higher lymph node yield and better short-term outcomes than open surgery: a large single-center comparative study. Dis Colon Rectum, 2013, 56(6): 679-688.
12. Trastulli S, Cirocchi R, Listorti C, et al. Laparoscopic vs open resection for rectal cancer: a meta-analysis of randomized clinical trials. Colorectal Dis, 2012, 14(6): e277-e296.
13. Kang SB, Park JW, Jeong SY, et al. Open versus laparoscopic surgery for mid or low rectal cancer after neoadjuvant chemoradiotherapy (COREAN trial): short-term outcomes of an open-label randomised controlled trial. Lancet Oncol, 2010, 11(7): 637-645.
14. 范莹, 吴硕东, 于宏, 等. 腹腔镜结直肠癌根治术与同期开腹手术对比的单中心回顾性研究. 中国普外基础与临床杂志, 2009, 16(5): 384-388.
15. 王向阳, 陈勇, 庞典付, 等. 腹腔镜结直肠癌根治性手术的临床疗效分析. 中国普通外科杂志, 2012, 21(4): 403-406.
16. Lujan J, Valero G, Hernandez Q, et al. Randomized clinical trial comparing laparoscopic and open surgery in patients with rectal cancer. Br J Surg, 2009, 96(9): 982-989.
17. 王树彦, 陈宗祐. 结直肠癌腹腔镜手术与开腹手术的短期疗效比较. 复旦学报: 医学版, 2010, 37(1): 92-99.
18. van der Pas MH, Haglind E, Cuesta MA, et al. Laparoscopic versus open surgery for rectal cancer (COLORⅡ): short-term outcomes of a randomised, phase 3 trial. Lancet Oncol, 2013, 14(3): 210-218.
19. Martínez-Pérez A, Carra MC, Brunetti F, et al. Short-term clinical outcomes of laparoscopic vs open rectal excision for rectal cancer: a systematic review and meta-analysis. World J Gastroenterol, 2017, 23(44): 7906-7916.
20. 林祥, 杨济峰, 李剑. 中、低位直肠癌应用腹腔镜直肠全系膜切除术治疗的临床研究. 齐齐哈尔医学院学报, 2014, 35(1): 63-64.
21. 熊懿. 腹腔镜直肠全系膜切除术治疗中、低位直肠癌的临床疗效分析. 中国普通外科杂志, 2015, 24(4): 616-618.
22. 傅卫, 袁炯, 王德臣, 等. 腹腔镜直肠全系膜切除术治疗中、低位直肠癌的临床安全性对比研究. 中国微创外科杂志, 2007, 7(6): 502-505.
23. Lee SD, Park SC, Park JW, et al. Laparoscopic versus open surgery for stageⅠ rectal cancer: long-term oncologic outcomes. World J Surg, 2013, 37(3): 646-651.
24. 孔祥兴, 李军, 丁克峰. 结直肠癌加速康复外科开展的要点和难点. 中华胃肠外科杂志, 2016, 19(3): 260-261.
25. González QH, Rodríguez-Zentner HA, Moreno-Berber JM, et al. Laparoscopic vs^ open total mesorectal excision for treatment of rectal cancer. Rev Invest Clin, 2008, 60(3): 205-211.
26. 李俊, 谭忆广, 周志涛, 等. 腹腔镜直肠全系膜切除治疗中下段直肠癌临床疗效的探讨. 中华肿瘤防治杂志, 2010, 17(22): 1865-1867.
27. 孙延东, 吴国豪, 张波, 等. 腹腔镜与开腹手术治疗直肠癌的临床对照研究. 中华胃肠外科杂志, 2014, 17(4): 369-372.
28. Deans C, Yeo MS, Soe MY, et al. Cancer of the gastric cardia is rising in incidence in an Asian population and is associated with adverse outcome. World J Surg, 2011, 35(3): 617-624.