单中心1184例结直肠癌腹腔镜手术的临床分析

Clinical analysis of laparoscopic surgery for colorectal cancer:a report of 1184 cases at a single center

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 evaluate the safety and feasibility of laparoscopic surgery for colorectal cancer,and its long-term surgical outcomes.Methods Clinical data of 1184 patients undergoing laparoscopic surgery for colorectal cancer from July 1999 to June 2009 in our Department of Gastrointestinal Surgery were analyzed retrospectively.The peri-operative and postoperative long-term results were evaluated.Results Sixty two laparoscopic operations were converted to open procedures,and the conversion rate was 5.24%(62/1184).Laparoscopic procedures were performed successfully in 1122 patients,including right hemi-colectomy in 154,transverse colectomy in 28,left hemi-colectomy in 67,sigmoid colectomy in 191,total colectomy in 8,high anterior resection in 221,low anterior resection in 216,ultralow anterior resection in 71,rectal pull-through resection via anus with colon-anal anastomosis in 5,abdominal-perineal resection in 132,Hartmann operation in 11 and palliative colostomy in 18 cases.The mean operation time was(188.40±72.76)min,median blood loss 100 ml,mean number of harvested lymph nodes(12.17±8.31),mean length of abdominal assisted incision(5.02 ± 2.83)cm,mean postoperative time to start eating(2.38±1.50)d and mean postoperative hospital stay(8.02±2.79)d.The complication rate was 14.79%(166/1122) within 30 days after operation,the most common complication was intestinal obstruction(4.81%,54/1122),the secondly common was postoperative urinary retention(2.94%,33/1122).The perioperative mortality was 0.09%(1/1122).The follow-up rate was 94.56%(1061/1122).The recurrence and metastasis rate was 14.60%(140/959),The 5-year survival rates were 92.0%,86.0%,72.0%,19.0% for Ⅰ～Ⅳ staged patients,5-year disease-free survival rates were 91.0%,85.0%,70.0% forⅠ～Ⅲ staged patients respectively.The overall 5-year survival rates of colonic and rectal cancer patients were 76.0% and 77.0%,while the 5-year disease-free survival rates were 71.0% and 74.0% respectively.Conclusions Laparoscopic operation for colorectal cancer is safe and feasible.The peri-operative and early surgical results are satisfied,and the long-term outcomes are comparable with open procedures.