结直肠癌合并胆囊疾病同期腹腔镜手术治疗的临床体会

Clinical experience of laparoscopic surgery for colorectal cancer combined with gallbladder disease

目的分析胆囊疾病合并结直肠癌同期行腹腔镜手术的安全性和疗效。方法采用描述性病例系列研究方法回顾性分析2016年1月至2020年12月期间完成的腹腔镜下胆囊切除联合结直肠癌根治术23例患者的病例资料,对手术相关数据和病理结果进行评价和分析。结果中转开腹手术1例,无围手术期二次手术病例,手术时间为(246.7±36.7)min,术中出血量为(106.6±51.5)ml,恢复进食时间为术后(4.8±2.74)日,术后住院时间为(12.3±5.3)日,总住院费用为(41397.6±13360.5)元。慢性胆囊炎伴胆囊结石为97.0%,肠癌浸润深度主要为T3(73.9%),淋巴结癌转移率为43.5%,术后总并发症发生率为21.7%,4例切口感染,1例吻合口瘘,均经对症治疗后好转。术后随访3~60个月,无新发胆道系统结石,8例出现结直肠肿瘤复发或转移。结论通过术前规划和术中微调,结直肠癌合并胆囊疾病患者同期行腹腔镜手术是安全可行的,而且患者的总费用明显减少,可避免多次住院、多次手术或多个切口的局面出现,减轻了患者的经济和身心负担。

Objective To analyze the safety and efficacy of laparoscopic surgery for gallbladder disease combined with color-ectal cancer.Method The data of 23 patients with laparoscopie cholcystectomy combined with radical resection of colorectal cancer from January 2016 to December 2020 were retrospectively analyzed by using descriptive case series study method,and the operation re-lated data and pathological results were evaluated and analyzed.Results The operation time was(246.7±36.7)min,the intraoper-ative blood loss was(106.6±51.5)ml,the time to resume eating was(4.8±2.74)days,the postoperative hospital stay was(12.3±5.3)days,and the total hospital cost was(41397.6±13360.5)yuan.Chronic cholecystitis with cholecystolithiasis was 97.0%.The mainly depth of invasion of carcinoma was T3(73.9%).The metastasis rate of lymph node carcinoma was 43.5%.The incidence of postoperative complications was 21.7%。Four cases of incision infection and one case of anastomotic leakage were improved after symptomatic treatment.The patients were followed up for 3-60 months,and no new bile duct stones were found.8 patients had colorec-tal tumor rcurrence or metastasis.Conclusion Through preoperative planning and intraoperative fine-tuning,it is safe and feasible for colorectal cancer patients with allbladder disease to undergo laparoscopic surgery at the same time,and the total cost of patients is significantly reduced,which can avoid the situation of muliple hospitalization,muliple operations or multiple incisions,and reduce the economic and physical burden of patients.