结肠镜与腹腔镜联合切除结直肠癌对腹腔脱落肿瘤细胞的影响

The Effects of Coloprotectomy under Colonscopy Combined with Laparoscope on Exfoliated Tumor Cells in Abdominal Cavity

目的探讨结肠镜与腹腔镜联合切除结直肠癌对腹腔脱落肿瘤细胞的影响。方法经病理诊断为结直肠癌42例，随机分成腹腔镜组（腹腔镜手术）和联合组（结肠镜与腹腔镜联合手术）。比较2组手术时间、肿瘤切除前后腹腔脱落肿瘤细胞阳性率、手术标本切缘残留肿瘤阳性率及术后并发症。结果联合组手术时间短于腹腔镜组[（160．5±12．6）min vs（201．2±18．4）min，t=-8．363，P=0．000]。两组肿瘤切除前腹腔脱落肿瘤细胞阳性率差异无显著性[9．5％（2／21）VS19．0％（4／21）,x^2=0．194，P=0．659]，切除后联合组明显低于腹腔镜组[14．3％（3／21）VS42．9％（9／21），x^2=4．200，P=0．040]。两组手术标本切缘均无残留肿瘤细胞。术后两组均痊愈出院，无切口感染、肺部感染。随访6—24个月，腹腔镜组1例腹部转移。结论结肠镜与腹腔镜联合切除结直肠癌可以减少腹腔肿瘤细胞的脱落，缩短手术时间。

Objective To stuey effects of coloprotectomy under colonoscopy combined with laparoscope on exfoliated tumor cells in abdominal cavity. Methods 42 cases of colorectal cancer proved by pathologic histology were devided into two groups randomly： Laparoscope Group （laparoscopic surgery） and Combined Group （colonoscopy combined with laparoscope surgery）. Operation time, the positive rate of exfoliated tumor cells in abdominal cavity after and before operation, the positive rate of residual tumor cells in resection of operation specimen and postoperative complications between 2 groups were compared. Results Operation time of the Combined Group was shorter than that of the Laparoscope Group [ （160.5 ± 12.6） min vs. （201.2 ± 18.4） min,t = -8. 363, P =0. 000]. The positive rate of exfoliated cells in abdominal cavity before operation had no significant difference between the 2 groups [ 9.5% （2/21） vs. 19.0% （4/21） ,X^2 = 0. 194, P =0. 659 ] , but the postoperative positive rate of exfoliated cells in the Combined Group was significantly lower than that in the Laparoscope Group [ 14.3% （ 3/21 ） vs. 42.9% （9/21） ,X^2 = 4. 200, P = 0. 040]. There were no residual tumor cells in resection of operation specimen of 2 groups. No infection of incisional wound and lung occurred. A follow-up for 6 - 24 months in the Laparoscope Group showed abdominal metastasis in 1 case. Conclusions Coloprotectomy for colorectal cancer under colonoscopy combined with laparoscope can decrease exfoliated tumor cells in abdominal cavity and shorten operation time.