腹腔镜一期切除治疗直肠癌合并同时性肝转移

Simultaneous laparoscopic excision for the treatment of rectal carcinoma and the synchronous hepatic metastasis

目的总结腹腔镜一期切除治疗直肠癌合并肝转移患者的临床效果。方法23例直肠癌合并同时性肝转移患者在行腹腔镜直肠癌切除的同时，行肝转移瘤切除，并与同期18例开腹一期切除直肠癌及肝转移瘤患者进行对比研究。全部患者术后均定期全身化疗。结果所有患者均顺利行直肠癌切除和肝转移瘤切除，腹腔镜组无中转开腹，两组患者均无手术死亡。腹腔镜组和开腹手术组的手术时间分别为（350±45）min和（342±38）min（P〉0.05），术中出血量分别为（275±96）ml和（590±85）ml（P〈0.01），住院时间分别为（12±1.5）d和（16±2.5）d（P〈0.05）。腹腔镜组有1例患者手术中输血200ml，而开腹手术组平均术中输血（500±100）ml（P〈0.01）。腹腔镜组患者的1、3、5生存率分别为82.6％、43.5％和8.6％，开腹手术组分别为77.8％、38.9％和0，差异无统计学意义（P〉0.05）。结论腹腔镜一期切除直肠癌合并同时性肝转移癌安全可行，具有创伤小、恢复快的优点，患者的生存期与开腹一期切除相当。

Objective To evaluate the therapeutic efficacy of simultaneous laparoscopic excision for the treatment of rectal carcinoma and synchronous hepatic metastasis. Methods Totally 38 patients with rectal carcinoma and synchronous hepatic metastasis detected by CT scan were included in this study. Among them, 23 patients in the group A were treated with laparoseopic surgery, and the other 18 patients in the group B with traditional abdominal operation to reseet the rectal tumor and hepatic metastasis simultaneously. All patients received postoperative chemotherapy. Results All the patients were treated successfully with no postoperative death in both groups. The mean operative time was 350±45 min in group A versus 342±38min in group B （P〉0.05）. The mean blood loss was 275±96 ml in group A versus 590±85 ml in group B （P〈0.01）, and the average hospital stay was 12±1.5 days in group A versus 16±2.5 days in group B （P〈0.05）. Only one patient in group A received blood transfusion of 200 ml during operation, while the average blood transfusion in group B was 500±100ml （P〈0.01）. The follow-up duration was from 36 to 72 months with an average duration of 45.3 months. The 1 -, 3- and 5-year survival rates were 82.6% , 43.5% and 8.6% in the group A, versus 77.8%, 38.9% and 0% in group B, respectively （P〉0.05）. Conclusion Simultaneous laparoscopic excision of rectal carcinoma and synchronous hepatic metastasis is safe, effective and minimally invasive with a similar survival achieved by traditional open abdominal operation.