腹腔镜下同期结直肠癌和肝转移灶切除术的安全性和疗效分析

Safety and effectiveness of simultaneous laparoscopic resection for colorectal cancer and synchronous liver metastasis

目的观察腹腔镜同期切除结直肠癌和肝转移灶的结果和预后。方法采用回顾性队列研究方法收集我科2011年1月1日-2013年8月1日的结直肠癌肝转移病人41例,其中腹腔镜手术组(观察组)18例,开腹手术组(对照组)23例,两组一般资料差异均无统计学意义。比较两组临床病理特征、围术期情况和长期随访结果。结果腹腔镜组术中估计出血量[(198.33±180.66)ml vs(686.96±665.76)ml,P=0.004]、术中输血例数(3 vs 11,P=0.037)和术后住院时间[(12.00±5.77)d vs(16.61±8.12)d,P=0.048]均显著低于开腹组。两组手术时间和术后并发症发生率、3年累计生存率差异均无统计学意义。结论腹腔镜同期切除结直肠癌和肝转移灶与开腹手术相比,患者的预后相当,并可减少术后出血,缩短住院时间,是安全有效的手术方式。

Objective To observe the outcomes and prognosis of patients undergoing simultaneous laparoscopic resection of colorectal cancer and synchronous liver metastasis. Methods A retrospective cohort study was performed in 41 patients with colorectal cancer and synchronous liver metastasis admitted to our department from January 1, 2011 to August 1, 2013. Of the 41 cases, 18 underwent simultaneous resection of colorectal cancer and liver metastasis by laparoscopic approach and 23 by open approach. There were no significant differences in general characteristics between two groups. All available clinical and pathologic data, perioperative results and survival outcomes were collected and compared. Results Estimated blood loss [（198.33±180.66） ml vs（686.96±665.76） ml, P=0.004）], intraoperative blood transfusion cases（11 vs 3, P=0.037） in open group were significantly higher than those of the laparoscopic group, and postoperative length of hospital stay in open group was longer than that of laparoscopic group [（12.00±5.77） d vs（16.61±8.12） d, P=0.048）]. No significant difference was observed in postoperative complications, operating time and three-year overall survival rate between the two groups. Conclusion For colorectal cancer patients simultaneous laparoscopic resection for colorectal cancer and synchronous liver metastasis is safe and effective, and achieves similar prognosis as open approach with less blood loss and shorter length of hospital stay.