梗阻性左半结肠癌支架置入后手术方式的选择

Optimal surgical approach after stent insertion for obstructive left-sided colonic cancer

目的比较梗阻性左半结肠癌支架置入后腹腔镜手术和开腹手术的治疗效果。方法回顾性分析北京朝阳医院2001-01-01-2019-12-31收治的118例左半结肠癌肠梗阻且放置支架患者的临床资料。根据患者行根治性手术的不同方式,将其分为腹腔镜手术组(62例)和开腹手术组(56例),比较2组患者短期疗效和长期预后。结果 2组患者年龄、性别、身体质量指数、肿瘤大小、部位和分期等临床病理指标差异均无统计学意义,均P>0.05。腹腔镜手术组平均手术时间为(168.2±33.2) min,长于开腹手术组的(143.5±27.4) min,t=4.390,P<0.001;术中出血量为(125.5±106.3) mL,少于开腹手术组的(196.0±194.5) mL,t=2.475,P=0.015;术后排气时间为(2.3±1.4) d,短于开腹手术组的(3.0±1.3) d,t=2.605,P=0.010;术后进食时间为(4.5±1.8) d,短于开腹手术组的(5.3±1.3) d,t=2.582,P=0.011;术后住院时间为(10.5±4.0) d,短于开腹手术组的(13.8±6.5) d,t=3.395,P=0.001;切口并发症发生率为4.8%,低于开腹手术组的16.1%,χ^(2)=4.064,P=0.044。2组患者肠造口率、总并发症发生率、吻合口瘘发生率、二次手术率和围手术期死亡率差异无统计学意义,均P>0.05。腹腔镜手术组与开腹手术组的5年无病生存率(55.05%vs 60.49%,χ^(2)=0.290,P=0.590)和总生存率(69.58%vs 77.53%,χ^(2)=0.617,P=0.432)差异均无统计学意义。结论梗阻性左半结肠癌患者支架置入后,腹腔镜手术安全可行,短期效果优于开腹手术,长期预后与开腹手术类似。

Objective To compare the outcomes of laparoscopic with open resection after stent insertion in patients with obstructive left-sided colonic cancer.Methods A total of 118 consecutive patients with obstructive left-sided colonic cancer from January 1 st, 2001 to December 31 st, 2019 in Beijing Chao-yang Hospital who underwent radical resection after successful stent insertion were retrospectively reviewed.According to different surgical approaches, patients were divided into two groups: laparoscopic surgery group(n=62) and open surgery group(n=56).The short-and long-term outcomes between the groups were compared.Results Both groups had similar demographic and tumor characteristics in terms of age, gender, body mass index, tumor size, location, and stage(all P>0.05).The mean operating time was longer in the laprascopic surgery group [(168.2±33.2)min vs(143.5±27.4) min, t=4.390,P<0.001].The intraoperative blood loss was(125.5±106.3) ml, in the laprascopic surgery group, which was less than that in the open surgery group(196.0±194.5) ml, t=2.475,P=0.015.The postoperative exhaust time was(2.3±1.4) d, which was shorter than the open surgery group(3.0±1.3) d, t=2.605,P=0.010.The postoperative eating time was(4.5±1.8) d, which was shorter than the open surgery group(5.3±1.3) d, t=2.582, P=0.011.Postoperative hospital stay was(10.5±4.0) d, which was shorter than the open surgery group(13.8±6.5) d, t=3.395,P=0.001.The incidence of incision complications was 4.8%,which was lower than the open surgery group 16.1%(χ^(2)=4.064,P=0.044).The following terms were similar between two groups, including the rate of stoma formation, overall postoperative complication rate, anastomotic leakage rate, re-operation rate, peri-operative mortality(all P>0.05).The 5-year disease-free survival rate(55.05% vs 60.49%,χ^(2)=0.290,P=0.590) and overall survival rate(69.58% vs 77.53%,χ^(2)=0.617,P=0.432) were not significantly different between two groups.Conclusions Laparoscopic surgery is safe and feasible for patients with obstructive left-sided colonic cancer after stent insertion.Laparoscopic resection is associated with better short-term outcomes and equivalent long-term outcomes when compared with open surgery.