腹腔镜根治术在结肠单发腺癌治疗中的应用

Application of laparoscopic radical resection in the treatment of solitary colon adenocarcinoma

目的对比分析腹腔镜根治术与开腹根治术治疗结肠单发腺癌时,在安全性、术后并发症及临床疗效等方面存在的差异性。方法选择2008年4月至2011年4月接受手术治疗的198例结肠单发腺癌患者。采用随机抽样的方法将其分为开腹组和腹腔镜组,每组99例。开腹组患者采取传统的开腹手术,切掉癌变的结肠部分;腹腔镜组患者采取腹腔镜根治术,在腹腔镜的配合下实施癌变结肠部分的切除手术。对两组患者术中和术后的一些相关指标、术后并发症、术后生活质量以及近远期术后的生存率等数据进行统计分析。结果腹腔镜组平均手术时间、术中出血量、术后肠功能恢复时间、术后排气时间、住院时间均低于开腹组（t=11.182、22.960、6.420、8.635、16.850,均P〈0.01）;开腹组术后并发症发生率高于腹腔镜组,差异有统计学意义（17.2%vs 2.0%,χ^2=13.100,P=0.000）。腹腔镜组术后5周时的总体生活质量评分优于开腹组（P〈0.01）。对于Ⅱ期结肠癌患者,腹腔镜组的术后5年总体生存率要优于开腹组。结论患者接受腹腔镜手术来治疗结肠单发腺癌的安全性以及临床疗效均优于开腹手术,且接受腹腔镜手术治疗的患者术后并发症发生率优于开腹手术。

Objective To compare the safety,postoperative complications and clinical outcomes of patients with single colon adenocarcinoma treated with laparoscopic radical or open radical operation.Methods One hundred and ninety-eight colon cancer cases from April 2008 to April 2011 were selected and divided into laparoscopic group and open surgery group randomly,with 99 cases in each group.The open surgery group were treated with traditional open surgery and cut off colon cancer.The operation of the colon resection was carried out with the cooperation of laparoscopic operation in the laparoscopic group.The data of postoperative complications,postoperative quality of life and survival rate after surgery were statistically analyzed between the two groups.Results In the laparoscopic group,the mean operation time,bleeding amount,postoperative intestinal function recovery time,exhausting time,and hospitalization time were lower than those in the open group（t=11.182,22.960,6.420,8.635,16.850,all P0.01）.The postoperative complication rate was higher in the open group,with statistically significant difference（17.2% vs 2.0%,χ^2=13.100,P=0.000）.Five weeks after operation,the total quality of life of the laparoscopic group was better than that of the open group（P0.01）.For patients with stage Ⅱ colon cancer,the 5-year overall survival rate of the laparoscopic group was better than that of the open group.Conclusion Laparoscopic surgery for colon cancer is better than open surgery in terms of safety,clinical efficacy,and postoperative complication rate.