腹腔镜结直肠癌根治术治疗不同分期结直肠癌的效果及安全性分析

Effectiveness and safety of laparoscopic radical operation in treating different stages of colorectal cancer

目的探讨腹腔镜结直肠癌根治术治疗不同分期结直肠癌的效果及安全性。方法回顾性分析2010年6月至2013年12月在首都医科大学附属北京安贞医院行结直肠癌根治术的449例患者的病历资料，TNM分期0～Ⅰ期216例，其中行腹腔镜手术治疗118例（腹腔镜A组）、行开腹手术治疗98例（开腹A组）；TNM分期Ⅱ～Ⅲ期233例，其中行腹腔镜手术治疗101例（腹腔镜B组）、行开腹手术治疗132例（开腹B组），末次随访截至2015年5月，分析不同分期患者腹腔镜和开腹手术手术情况、肿瘤学指标、术后并发症、局部复发率、远处转移率及1年、3年生存率。结果腹腔镜A组手术时间、出血量均明显少于开腹A组（t=-4.256、-6.548，均P〈0.001）；腹腔镜B组出血量明显少于开腹B组（t=-5.216，P〈0.001）。腹腔镜B组共9例中转开腹，其中结肠癌患者5例，中转开腹率为6.2%（5/81），直肠癌患者4例，中转开腹率为20.0%（4/20）。腹腔镜A组切口感染发生率明显低于开腹A组（χ2=4.855，P=0.040），腹腔镜B组切口感染发生率明显低于开腹B组（χ2=5.368，P=0.022）；腹腔镜A组术后局部复发率为2.8%，远处转移率为1.3%，1年生存率为98.4%，3年生存率为94.5%；开腹A组术后局部复发率为2.4%，远处转移率为1.2%，1年生存率为98.8%，3年生存率为95.3%。腹腔镜B组术后局部复发率为4.8%，远处转移率为5.3%，1年生存率为94.9%，3年生存率为85.8%；开腹B组术后局部复发率为4.1%，远处转移率为4.3%，1年生存率为95.3%，3年生存率为87.9%。术后局部复发率、远处转移率、1年和3年生存率，腹腔镜A组和开腹A组比较差异均无统计学意义（χ2=0.958、0.911、0.856、0.977，P=0.618、0.632、0.674、0.598），腹腔镜B组和开腹B组比较差异均无统计学意义（χ2=1.214、1.256、1.014、1.325，P=0.415、0.402、0.389、0.231）。结论腹腔镜技术在0～Ⅲ期结肠癌及0～Ⅰ期直肠癌根治手术中应用均有较好的疗效和安全性，Ⅱ～Ⅲ期直肠癌患者的中转开腹率仍然较高，手术安全性存在风险，应严格做好术前评估。

ObjectiveTo investigate the effectiveness and safety of laparoscopic radical operation for different stages of colorectal cancer. MethodsTotally 449 patients who had laparoscopic radical operation for colorectal cancer from June 2010 to December 2013 at Beijing Anzhen Hospital, Capital Medical University were retrospectively analyzed. Among 216 cases of TNM stage 0-Ⅰ, 118 cases had laparoscopic operation （laparoscopy group A） and 98 cases had open abdominal operation（laparotomy group A）; among 233 cases of TNM stage Ⅱ-Ⅲ, 101 cases had laparoscopic operation（laparoscopy group B） and 132 cases had open abdominal operation（laparotomy group B）. The postoperative follow-up ended in May 2015; operation data, oncology indexes, postoperative complications, local recurrence, distant metastasis and 1-, 3-year survival were analyzed. ResultsOperation duration and blood loss in laparoscopy group A were significantly less than those in laparotomy group A（t=-4.256, -6.548, all P〈0.001）; the blood loss in laparoscopy group B was significantly less than that in laparotomy group B（t=-5.216, P〈0.001）. Nine cases in laparoscopy group B had secondary laparotomy; the conversion rate of colon cancer was 6.2%（5/81）and the conversion rate of rectal cancer was 20.0%（4/20）. The incidence of incision infection in laparoscopy group A was significantly lower than that in laparotomy group A（χ2=4.855, P=0.040）; the incidence of incision infection in laparoscopy group B was significantly lower than that in laparotomy group B（χ2=5.368, P=0.022）. Local recurrence rate, distant metastasis rate, 1-year survival rate and 3-year survival rate had no significant differences among laparoscopy group A（2.8%, 1.3%, 98.4%, 94.5%）, laparotomy group A（2.4%, 1.2%, 98.8%, 95.3%）, laparoscopy group B（4.8%, 5.3%, 94.9%, 85.8%） and laparotomy group B（4.1%, 4.3%, 95.3%, 87.9%）. ConclusionsLaparoscopic radical operation is safe and effective in treating TNM stage 0-Ⅲ colon cancer and TNM stage 0-Ⅰ rectal cancer; the conversion rate of laparoscopic operation to laparotomy in patients with TNM stage Ⅱ-Ⅲ rectal cancer is relatively high.