新辅助化疗联合腹腔镜手术治疗大肠癌的临床疗效观察

The clinical effect of neoadjuvant chemotherapy combined with laparoscopic operation in the treatment of colorectal cancer

目的探讨进展期大肠癌在新辅助化疗后行腹腔镜手术治疗的疗效。方法收集2008年7月-2012年12月的住院患者资料,对78例进展期大肠癌患者行术前全身化疗4个周期（FOL FOX4方案）,并于化疗结束3周后行腹腔镜辅助下大肠癌根治术。结果经新辅助化疗,肿瘤的TNM分期得到降低,无三级以上的不良反应发生。该组78例患者行4周期化疗后行腹腔镜辅助下大肠癌根治术,手术顺利,无中转开腹,平均手术时间160（120-220）min,平均术中出血150（100-400）mL,术后胃肠功能恢复时间1-2 d,平均住院时间10（8-14）d,术中及术后无严重并发症,术后病检：腹腔镜手术共清扫淋巴结786枚,转移201枚。该组中有9例因术后并发肝肺转移于术后2年内死亡,3例术后腹腔广泛转移,2例脑转移死亡,除失访7例外,余57例均存活至今未发现局部复发、远处转移病例。结论进展期大肠癌行新辅助化疗后能显著降低肿瘤的临床分期,增加R0的切除率,不同程度的缩小了肿瘤体积,减少淋巴结的转移,联合腹腔镜提高了微创手术对大肠癌的根治机会。

【Objective】To explore the effect of advanced colorectal cancer with neoadjuvant chemotherapy followed by laparoscopic operation treatment.【Methods】From 2008 July to 2012 December, among the patients, 4 cycles in 78 patients with advanced colorectal cancer underwent preoperative chemotherapy（FOL FOX4）, chemotherapy after 3 weeks of laparoscopic assisted colorectal cancer radical resection.【Results】After neoadjuvant chemotherapy, tumor TNM stage was reduced, no adverse reaction occurred above level three. Radical resection in 78 cases, the 4 cycle of chemotherapy were performed laparoscopic colorectal cancer operation successfully, without conversion to laparotomy, the average operation time was 160 min（120-220 min）, the average intraoperative bleeding was 150 mL（100-400 mL）, postoperative gastrointestinal function recovery time of 1-2 d, the average length of time（8- 14 d）, no serious intraoperative and postoperative complications, postoperative pathological examination in laparo-scopic operation： 786 lymph nodes were dissected, transfer 201. There were 9 patients with postoperative liver and lung metastasis in postoperative death within 2 years, 3 cases of abdominal postoperative metastasis, 2 patients died of brain metastasis, loss to follow-up of 7 cases, 57 cases were survived so far found local recurrence, distant metastasis.【Conclusion】Advanced colorectal cancer underwent neoadjuvant chemotherapy can significantly reduce tumor clinical stage, increase the R0 removal rate, reduce tumor volume at different degrees, reduce lymph node metastasis, combined with laparoscopic minimally invasive operation on colorectal cancer improves the chance of radical.