腹腔镜根治术与传统开腹手术治疗结肠癌的安全性和长期生存分析

Analysis on security and long-term survival of laparoscopic radical surgery and traditional open surgery in the treatment of colon cancer

目的对比腹腔镜与传统开腹结肠癌根治术的疗效及预后。方法选取2007年1月~2010年2月我院收治的80例结肠癌患者作为研究对象,采用随机数字表法将所选患者分为研究组和对照组,每组40例。对照组采用传统开腹结肠癌根治术,研究组采用腹腔镜结肠癌根治术。随访5年,综合比较两组患者的手术时间、术中出血量、淋巴结获取数、术后排气时间、住院时间、并发症情况、术后5年累积总体生存率、5年累积局部复发率及无瘤生存率。结果研究组的手术时间长于对照组（P〉0.05）,两组的淋巴结获取数比较差异无统计学意义（P〉0.05）;研究组的术中出血量少于对照组,术后排气时间、住院时间短于对照组（P〈0.01）;研究组患者出现切口感染、出血、肠梗阻、吻合口漏、腹腔感染、呼吸衰竭等的并发症发生率为5.0%,低于对照组的27.5%（P〈0.01）;两组患者术后5年累积总体生存率、5年累积局部复发率及无瘤生存率比较差异均无统计学意义（P〉0.05）。结论腹腔镜结肠癌根治术安全有效,具有创伤小、出血量少、胃肠道功能恢复快等优点,并可获得与开腹手术相当的术后5年总体生存率和无瘤生存率。

Objective To compare the effect and prognosis of laparoscopic and traditional open radical surgery for colon cancer. Methods 80 cases with colon cancer treated in our hospital from January 2007 to February 2012 were selected as study objects,and they were randomly divided into research group and control group according to the random number table method,and each group has 40 cases.Control group was treated with traditional open surgery.Research group was treated with laparoscopic radical surgery.All patients were followed up for 5 years.The operation time,blood loss during operation,lymph nodes access number,postoperative discharge time,hospitalization time,complications,5-year cumulative overall survival rate,5-year cumulative local recurrence rate and tumor-free survival rate after operation was comprehensively compared respectively in patients between two groups. Results The operation time in research group was longer than that of control group（P〉0.05）,and there was no statistical difference of lymph nodes access number between two groups（P〉0.05）.The blood loss during operation was less than that of control group,postoperative discharge time and hospitalization time in research group was lower than that of control group respectively（P〈0.05）.The incidence rate of complications such as incision infection, hemorrhage,intestinal obstruction,anastomotic leakage,abdominal infection and respiratory failure and so on was 5.0% in patients of research group,which was lower than that of control group（27.5%）（P〈0.01）.There was no statistical difference of 5-year cumulative overall survival rate,5-year cumulative local recurrence rate and tumor-free survival rate after operation between two groups（P〉0.05）. Conclusion Laparoscopic radical surgery for colon cancer is effective and safe with advantages such as small trauma,less bleeding loss and faster recovery of gastrointestinal function and so on,and it obtains 5-year overall survival rate after operation equivalent to open surgery.