腹腔镜与结肠镜联合治疗早期结直肠肿瘤的临床效果分析

Clinical efficacy of laparoscopic surgery combined with colonoscopy procedure in the treatment of early colorectal tumor

目的分析腹腔镜联合结肠镜治疗早期结直肠肿瘤的临床疗效,进一步说明双镜联合技术在早期结直肠肿瘤治疗中的应用价值。方法回顾性分析2014年1月—2017年5月在江苏大学附属医院应用双镜联合技术治疗31例早期结直肠肿瘤患者的临床资料,结肠镜进行全结直肠内病灶探查并定位,术中根据快速冰冻病理结果选择在腹腔镜下行相应手术治疗。结果 31例均顺利完成腹腔镜联合结肠镜手术,22例术前诊断为Ⅰ期结直肠癌,术后诊断Ⅰ期20例(T1N0M0期13例,T2N0M0期7例),Ⅲ期2例(T2N1M0期)。9例术前诊断为癌前病变,术后病理诊断为高级别上皮内瘤变2例,7例为高级别上皮内瘤变伴局灶癌变。其中6例患者为多灶病变同期行肠管其他部位息肉切除术,术中快速冰冻病理证实为低级别腺瘤样息肉,没有追加手术。31例均获随访,全部患者均术后半年门诊复查肠镜,以后每年复查1次,同时监测肿瘤标志物。随访时间6～42个月,中位时间为32个月,随访期间未见有复发转移患者。1例术后2年死于脑梗塞,其余存活至今。结论腹腔镜联合结肠镜技术治疗早期结直肠肿瘤可发挥两者优势,尤其适用于单镜难以定位或完全切除的病变,可提高治疗精确性及手术安全性。

Objective To analyze the colonoscopy-assisted laparoscopic surgery in the treatment of early colorectal tumor, and further elevate the application value of them in the treatment of early colorectal cancer. Methods From January, 2014 to May, 2017, a total of 31 early colorectal tumor patients were treated with eolonoscopy-assisted laparoscopic surgery in our hospital. Locations of colorectal lesions were explored by colonoseopy. According to the rapid frozen pathological results, laparoseopie surgery was selected. Results All patients were treated with colonoseopy-assisted laparoscopie surgery successfully, with no conversion to laparotomy. Among 22 cases of preoperative diagnosis of stage I colorectal cancer, there were 20 cases of intraoperative and postoperative diagnosis of stage I （13 cases of T1N0M0, 7 cases of T2NOM0） and 2 cases of stage m （T2N1M0）. There were 9 cases of preoperative diagnosis of precancerous lesions, 2 of which were diagnosis of high grade intraepithelial neoplasia and 7 cases were diagnosis of high grade intraepithelial neoplasia with carcinogenesis. 6 cases were under polypectomy at the same time, the rapid frozen pathological results proved to be a low level adenomatoid polyp during the operation, and no additional surgery was performed. All patients were ex- amined by colonoscopy half a year after operation. After that, 1 time a year was reviewed, and tumor markers were monitored at the same time. All patients were followed up 6 - 42 months, with a median of 32 months. Most of the patients were alive without recurrence except one case died of cerebral infarction 2 years after operation. Conclusion Laparoscopy combined with colonoseopy in treatment of early colorectal tumor has advantages of both endoscopy, especially suitable for lesions with difficult location or complete resection, which can improve surgical accuracy and safety.