腹腔镜联合肛门内镜治疗左半结肠癌的临床效果观察

Effect of laparoscopy combined with anal endoscopy in treating left-sided colon cancer

目的探讨腹腔镜联合肛门内镜治疗左半结肠癌的临床效果及对患者生存期的影响。方法纳入2011年3月至2012年9月本院80例左半结肠癌患者作为研究对象,利用随机数字表将患者分为观察组和对照组,每组各40例。观察组行腹腔镜联合肛门内镜手术治疗,对照组行单纯腹腔镜左半结肠癌根治术。比较两组手术基本情况、术后并发症发生率及术后5年生存情况。结果观察组术中出血量和术后疼痛评分均优于对照组,术后住院时间短于对照组,差异均有统计学意义(均P<0.05),两组手术时间、切除标本长度、淋巴结清扫数目及术后首次肛门排气时间差异均无统计学意义(均P> 0.05)。观察组术后5年失访2例,总生存和无进展生存分别为27例和24例;对照组失访3例,总生存25例,无进展生存20例。两组术后5年总生存率和无进展生存率差异均无统计学意义(Log-rank X^2=0.432、0.793,P=0.511、0.373)。结论腹腔镜和肛门内镜双镜联合手术用于治疗肿瘤直径<4 cm的左半结肠癌患者,能获得与单纯腹腔镜根治手术相当的远期治疗效果,避免了腹部辅助切口,且有助于减轻术后疼痛,促进患者术后康复。

Objective To investigate the clinical effect of laparoscopy combined with anal endoscopy in treating left-sided colon cancer and its effect on survival. Methods 80 patients with left-sided colon cancer treated in our hospital from March 2011 to September 2012 were recruited as study subjects and were randomly assigned using random number table to treatment group and control group, with 40 patients in each group. Patients in the treatment group received laparoscopic radical surgery combined with anal endoscopy and patients in the control group received laparoscopic radical surgery for left colon cancer. Indices related to surgery, incidence of postoperative complications and five-year survival after surgery were compared between the two groups. Results Amount of blood loss during surgery and postoperative pain score were significantly lower, and duration of hospitalization was significantly shorter in the treatment group than in the control group （P 〈 0.05）. Duration of surgery, length of resected specimen, number of lymph node dissection and time to first postoperative anal exhaust were comparable between the two groups （P 〉 0.05）. In the treatment group, 2 patients lost to follow-up, 27 survived and 24 were progression-free. The corresponding figures in the control group were 3, 25, and 20 patients, respectively. There was no significant difference between the two group in overall five-year survival and progression-free survival （Log-rankχ^2= 0.432 and 0.793, respectively, P = 0.511 and 0.373, respectively）. Conclusion Long-term treatment effect was comparable between combination of laparoscopy and anal endoscopy and laparoscopy alone in treating patients with left-sided colon cancer with diameter of tumor 〈 4 cm. The former is abdominal incision-free, therefore, can alleviate postoperative pain and promote recovery.