论文部分内容阅读
目的探讨腹腔镜手术治疗结直肠癌的安全性和可行性,评价其远期疗效。方法 对我院胃肠外科在1999年7月至2009年6月间施行腹腔镜手术的1184例结直肠癌患者的临床资料进行回顾性分析,评价其围手术期手术情况及远期疗效。结果腹腔镜手术中开腹中转率5.24%(62/1184),1122例顺利完成腹腔镜手术,其中右半结肠切除术154例,横结肠切除术28例,左半结肠切除术67例,乙状结肠切除术191例,全结肠切除术8例,高位直肠前切除术221例,低位直肠前切除术216例,超低位直肠前切除术71例,直肠癌拖出式切除结肠肛管吻合术5例,腹会阴切除术132例,Hartmann术11例,姑息造瘘术18例。平均手术时间(188.40±72.76)min,中位出血量100ml,平均清扫淋巴结数(12.17±8.31)枚,腹部辅助切口平均长度(5.02±2.83)cm,平均术后开始进食时间(2.38±1.50)d,平均术后住院日(8.02±2.79)d。术后30天内并发症发生率为14.79%(166/1122),最常见为肠梗阻(4.81%,54/1122),其次是术后尿潴留(2.94%,33/1122)。围手术期死亡率0.09%(1/1122)。全组患者随访率94.56%(1061/1122)。Ⅰ～Ⅳ期患者术后5年生存率分别为92.0%、86.0%、72.0%、19.0%,Ⅰ～Ⅲ期患者术后5年无瘤生存率分别为91.0%、85.0%、70.0%。结肠癌及直肠癌患者的5年总体生存率分别为76.0%、77.0%,5年无瘤生存率分别为71.0%、74.0%。结论腹腔镜手术治疗结直肠癌是安全可行的。早期疗效令人满意,远期结果与开腹手术可比。
Objective To investigate the safety and feasibility of laparoscopic surgery for colorectal cancer and evaluate its long-term efficacy. Methods The clinical data of 1184 colorectal cancer patients who underwent laparoscopic surgery from July 1999 to June 2009 in our hospital were retrospectively analyzed to evaluate their perioperative surgical outcomes and long-term efficacy. Results Laparoscopic surgery laparotomy rate of 5.24% (62/1184), 1122 cases of successful laparoscopic surgery, including 154 cases of right hemilaminectomy, transverse colon resection in 28 cases, left colon resection in 67 cases, sigmoid resection 191 cases of surgery, total colon resection in 8 cases, 221 cases of high rectal resection, low rectal resection in 216 cases, ultra-low rectal resection in 71 cases, rectal cancer pull-out resection of colorectal anastomosis in 5 cases, Abdominal perineal resection in 132 cases, Hartmann in 11 cases, palliative fistulation in 18 cases. The average operative time was 188.40 ± 72.76 min, the median amount of bleeding was 100 ml, the average number of lymph nodes (12.17 ± 8.31), the average length of abdominal assistant incision (5.02 ± 2.83) cm and the average postoperative start time (2.38 ± 1.50) d, the average postoperative hospital stay (8.02 ± 2.79) d. The incidence of complications within 30 days after operation was 14.79% (166/1122), the most common was intestinal obstruction (4.81%, 54/1122), followed by postoperative urinary retention (2.94%, 33/1122). Perioperative mortality was 0.09% (1/1122). The overall follow-up rate was 94.56% (1061/1122). The 5-year survival rates of stage Ⅰ-Ⅳ patients were 92.0%, 86.0%, 72.0% and 19.0% respectively. The 5-year disease-free survival rates of stage Ⅰ-Ⅲ patients were 91.0%, 85.0% and 70.0%, respectively. The 5-year overall survival rates of patients with colon cancer and rectal cancer were 76.0% and 77.0%, respectively. The 5-year disease-free survival rates were 71.0% and 74.0%, respectively. Conclusion Laparoscopic surgery for colorectal cancer is safe and feasible. Early efficacy is satisfactory, long-term results comparable with open surgery.