腹腔镜切除同时性肝转移Ⅳ期大肠癌的临床研究

Clinical study of the laparoscopic excision on colorectal carcinoma with simultaneous hepatic metastasis

目的探讨腹腔镜切除同时性肝转移Ⅳ期大肠癌的临床疗效和微创优势。方法采用与同期开腹手术相比较的方法,将2001年10月至2009年6月已有无法切除同时性肝转移的Ⅳ期大肠癌行结直肠癌切除的患者分为腹腔镜手术组(14例)和开腹手术组(15例),比较两组标本的病理结果、围手术期情况、肝转移癌灶的处理方法,评价各组的肿瘤根治性、手术安全性、术后恢复情况和近期随访结果。结果腹腔镜组术中出血量明显减少(P<0.05),术后应用吗啡镇痛剂量明显减少(P<0.01),术后离床时间和术后住院日数明显减少(P<0.05)。肿瘤根治性相关临床病理学结果提示两组病例完全可以达到相同的根治程度,腹腔镜组未发现Trocar穿刺部位及小切口部位肿瘤种植转移。两组均能够完成同样的肝转移癌灶局部处理(P>0.05)。结论对无法切除同时性肝转移的大肠癌,可以在行腹腔镜原发大肠癌灶切除的同时治疗已经不能够手术切除的肝转移癌灶,在手术安全性、术后近期疗效、微创等方面都有较明显的优势,具有可行性。

Objective To compare the results of laparoscopic excision and traditional operation on colorectal carcinoma with simultaneous hepatic metastasis.Methods Between October 2001 to June 2009,compared operation safety,tumor excision outcome,lymph nodes clearance,treatment of simultaneous hepatic metastasis and short term outcome for the two groups of patients undergoing either laparoscopic(lapa group 14 cases) or open operation(ope group 15 cases) for colon and rectal carcinoma.Results The blood loss was obviously diminution,antinociceptive drugs was obviously decreased in lapa group(P < 0.05);Time to resume early activity and hospital stay in lapa group were significantly shorter than those in ope group(P < 0.05);Clinical pathology finding show the same radical cure for the two groups(P > 0.05),there was not found that Trocar prick metastasis.No significant difference between the two groups was observed for the treatment of hepatic metastases(P > 0.05) .Conclusions Laparoscopic carcinosectomy for colorectal cancer with simultaneous hepatic metastasis can be performed safely,effectively with the advantages of minimal invasiveness.