腹腔镜联合内窥镜在早期结肠癌治疗中的应用

Laparoscopic and endoscopic cooperative surgery in the Treatment of Early Colon Cancer

目的：探讨腹腔镜联合内窥镜在早期结肠癌治疗中的应用价值。方法：回顾性分析我研究所2002年3月至2007年12月应用双镜联合治疗55例早期结肠癌患者的临床资料。结果：55例双铙联合治疗患者．根据术前电子肠镜活检病理结果，先行内窥镜定位腹腔镜游离结肠肠段切除术。术中切除标本送检快速冰冻切片病理检查，结果证实11例癌肿浸润至黏膜下层，均追加腹腔镜结肠癌根治术，其中2例伴有区域淋巴结转移，术后给予常规辅助化疗。中转开腹手术2例，无术后并发症。术后借助我所随访管理辅助信息系统，所有病例均获长期随访，除1倒术后1午死于心肌梗死外，其余患者存活至今。平均随访42个月（3～72个月）．均未见任何复发转移。结论：双镜联合应用。对病灶定位准确，减少了手术创伤。术中应用快速冰冻切片病理检查，增加了治疗的安全性，对于内窥镜下切除风险较大或内窥镜下切除术后仍有癌组织残留的早期结肠癌。双镜联合手术是有效治疗方法之一。

Objective： An early colon carcinoma is TNM stage TINxMx. This study aimed to investigate the value of laparoscopic and endoscopic cooperative surgery （LECS） in the treatment of early colon carcinoma. Method： The medical records of 55 early colon cancer patients （30 male, 25 female, median age 54 years [range 42 - 68]） undergoing Laparoseopic and andoscopic cooperative surgery at the colon were reviewed prospectiveJy. Results： From March 2002 to December 2007, 55 early colon cancer patients were treated with Laparoscopic and endo6copie cooperative surgery in Research Institute of General Surgery of Nanjing Military Command. In 55 cases, a Laparoscopie and endoscopic cooperative bowel segment resection was performed at first. And then, in 11 cases, a Laparoecopic and endoscopic cooperative radical anatomical resection was performed according to the result of frozen section. Two cases of T1NIMx were given adjuvant chemotherapy . There was no complications. In two cases （3. 64 96 ）, a conversion to open surgery was necessary. Follow - up data were obtained by clinical examination and personal ommunication via telephone. The median follow up was 42？ months （range 42 - 68）. All the patients are still alive except one case died of myocardial infarction during the followup period. None of the patients with early colon cancer treated by the cooperative surgery had a relapse or metastases. Conclusion： Laparcecopic and endoscopic cooperative surgery offer a minimalinvasive and safe therapeutic approach allowing the early colon cancer. The early colon cancer may be a good indication for Laparoecopic and endoscopic cooperative surgery when the endoscopic mucosal resection was inadequate.