腹腔镜下结直肠癌肝转移同时根治切除的临床研究

Clinical study of laparoscopic radical resection for colorectal cancer with liver metastasis

目的研究腹腔镜结直肠癌根治性切除联合腹腔镜切除治疗结直肠癌肝转移的临床疗效。方法回顾性分析2014年1月至2015年12月确诊为同时性结直肠癌肝转移患者90例资料。分为腹腔镜组(n=45)和开腹组(n=45),采用SPSS21.0统计软进行数据分析,术中术后指标采用(x±s)表示,独立t检验;术后并发症采用χ~2检验;偏态分布的资料采用M(Qn)和M(范围)表示,应用Mann-Whitney U检验。P<0.05为差异有统计学意义。结果两组患者手术时间、术中出血量、术中输血量、神经浸润及脉管侵犯等差异无统计学意义(P>0.05)。术后情况:两组患者在进食时间、术后TBIL、术后ALT、并发症及住院时间差异无统计学意义(P>0.05);而腹腔镜组入住ICU的患者时间为(2.1±1.6)d,明显短于开腹组(1.0±06)d(t=1.804,P<0.05)。随访结果:两组术后1、2年累积无瘤生存率和生存时间差异无统计学意义(P>0.05)。结论腹腔镜结直肠癌根治性切除术联合腹腔镜肝切除术在安全性优于腹腔镜结直肠癌根治性切除治疗联合开腹肝切除术,但两种治疗方法在术后并发症发生率及临床预后等方面效果相当。

Objective To study the clinical effect of laparoscopic radical resection of colorectal cancer combined with laparoscopic resection for the treatment of liver metastasis of colorectal cancer. Methods The data of 90 patients with synchronous eolorectal cancer liver metastases from January 2014 to December 2015 were retrospectively analyzed. The subjects were divided into laparoscopic group （n =45） and open group （n = 45 ）. SPSS21.0 statistical soft data analysis was used. Intraoperative and postoperative indicators were used （x ± s） , independent t test. χ2 test was used for the postoperative complications. The skewed distribution data are represented by M （Qn） and M. Use Mann-Whitney U test. The difference was statistically significant in P 〈 0.05. Results There was no significant difference in operative time, intraoperative blood loss, intraoperative blood transfusion, nerve infiltration and vascular invasion between the two groups （ P 〉 0.05 ）. Postoperative condition ： There was no significant difference in eating time, postoperative TBIL, postoperative ALT, complications and length of stay between the two groups （ P 〉 0.05 ）. The time of admission to ICU in laparoseopic group was （ 2. 1 ± 1.6 ） d, which was significantly shorter than that in laparotomy group （1.0 ±06） d （t = 1. 804, P 〈0.05）. Follow up： there was no significant difference in eunlulative tumor free survival and survival time between the two groups in 1 and 2 years after operation （ P 〉 0. 05 ）. Conclusion Laparoscopic radical resection of colorectal cancer combined with laparoscopic hepatectomy is safer than laparoscopie radical resection of colorectal cancer combined with open hepatectomy, but the two treatment methods have the same effect in postoperative complications and clinical prognosis.