模式化腹腔镜左半结肠癌根治术的临床价值

Clinical value of stylized laparoscopic hemicolectomy for left colon cancer

目的探讨模式化腹腔镜左半结肠癌根治术的临床价值。方法采用回顾性描述性研究方法。收集2016年1月至2020年12月南京医科大学第一附属医院收治的174例行腹腔镜左半结肠癌根治术患者的临床病理资料;男106例,女68例;年龄为59(17~86)岁。所有患者行模式化腹腔镜左半结肠癌根治术。观察指标:(1)手术情况。(2)术后并发症情况。(3)术后组织病理学检查情况。(4)随访情况。采用门诊或电话方式进行随访。术后2年内每3个月随访1次,2~5年每6个月随访1次,5年后每12个月随访1次,了解患者术后肿瘤复发、转移和生存情况。随访终点为肿瘤复发、转移或患者死亡。随访时间截至2021年10月。正态分布的计量资料以x±s表示。偏态分布的计量资料以M(范围)或M(Q1,Q3)表示。计数资料以绝对数或百分比表示。采用Kaplan-Meier法绘制生存曲线并计算生存率。结果(1)手术情况:174例患者均顺利完成模式化腹腔镜左半结肠癌根治术,其中6例术前行肠道支架置入(因肿瘤导致肠梗阻),3例行预防性末端回肠造口,1例行Hartmann手术。174例患者手术时间为97(80,106)min,术中出血量为45(25,60)mL,术后首次肛门排便时间为5(3,6)d,术后住院时间为7(6,8)d。(2)术后并发症情况:174例患者中,12例发生并发症,其中切口感染和(或)脂肪液化4例,吻合口漏3例,不全性肠梗阻2例,腹腔出血、乳糜漏、肺部感染各1例。2例吻合口漏患者行末端回肠造口术。1例腹腔出血患者行剖腹探查腹腔成功止血。1例高龄患者术后发生肺部感染死亡。其余患者均经保守治疗后好转。(3)术后组织病理学检查情况:174例患者中,肿瘤TNM分期Ⅰ期27例,Ⅱ期68例,Ⅲ期77例,Ⅳ期2例;肿瘤高分化9例,中分化107例,低分化58例。174例患者淋巴结检出数目为19(15,23)枚,阳性淋巴结检出数目为0(0,2)枚,肿瘤长径为4(3,5)cm。174例患者中,淋巴结转移79例,癌结节21例,脉管侵犯35例,神经侵犯29例。(4)随访情况:174例患者中,157例获得随访,随访时间为27(1~70)个月。157例获得随访的患者中,20例出现肿瘤转移,其中9例多发转移、5例肝转移、4例肺转移、骨转移和脾脏转移各1例。157例患者5年总生存率、无瘤生存率分别为90.9%、80.8%。结论模式化腹腔镜左半结肠癌根治术安全、可行。

Objective To investigate the clinical value of stylized laparoscopic hemicolec-tomy for left colon cancer.Methods The retrospective and descriptive study was conducted.The clinicopathological data of 174 patients who underwent laparoscopic hemicolectomy for left colon cancer in the First Affiliated Hospital of Nanjing Medical University from January 2016 to December 2020 were collected.There were 106 males and 68 females,aged 59(range,17‒86)years.All patients underwent stylized laparoscopic hemicolectomy for left colon cancer.Observation indicators:(1)surgical situations;(2)postoperative complications;(3)postoperative histopathological examinations;(4)follow-up.Follow-up was conducted using outpatient examination or telephone interview to detect tumor recurrence and metastasis and survival of patients up to October 2021.Follow-up was performed once every 3 months within postoperative 2 years,once every 6 months within postoperative 2 to 5 years and once a year after postoperative 5 years,with the end point as tumor recurrence and metastasis or death of patients.Measurement data with normal distribution were represented as Mean±SD and measurement data with skewed distribution were represented as M(range)or M(Q1,Q3).Count data were described as absolute numbers or percentages.Kaplan-Meier method was used to draw survival curve and calculate survival rate.Results(1)Surgical situations.All the 174 patients underwent stylized laparoscopic hemicolectomy for left colon cancer successfully,including 6 cases receiving preoperative enteral stent placement due to bowel obstruc-tion,3 cases receiving defunctioning ileostomy and 1 case receiving Hartmann procedure.The operation time,volume of intraoperative blood loss,time to postoperative initial defecation and duration of postoperative hospital stay of the 174 patients were 97(80,106)minutes,45(25,60)mL,5(3,6)days and 7(6,8)days,respectively.(2)Postoperative complications.Twelve of the 174 patients had complications,including 4 cases with incision infection or fat liquefaction,3 cases with anastomotic leakage,2 cases with incomplete bowel obstruction,1 case with abdominal hemo-rrhage,1 case with chylous leakage and 1 case with pulmonary infection.The 2 cases with anastomotic leakage underwent ileostomy.The patient with abdominal hemorrhage underwent laparotomy to stop bleeding.One elder patient died of postoperative pulmonary infection.The other patients with complications recovered with conservative treatment.(3)Postoperative histopatho-logical examinations.Of the 174 patients,there were 27 cases in stageⅠof TNM staging,68 cases in stageⅡ,77 cases in stageⅢand 2 cases in stageⅣ.There were 9 cases with well differentiated tumor,107 cases with moderately differentiated tumor and 58 cases with poorly differentiated tumor.The number of lymph node detected,the number of positive lymph node and tumor diameter of the 174 patients were 19(15,23),0(0,2)and 4(3,5)cm,respectively.Of the 174 patients,there were 79 cases with lymph node metastases,21 cases with cancerous nodules,35 cases with vascular invasion and 29 cases with nerve invasion.(4)Follow-up.Of the 174 patients,157 cases were followed up for 27(range,1‒70)months.Of the 157 patients who conducted follow-up,20 cases had tumor metastasis,including 9 cases with multiple metastasis,5 cases with liver metastasis,4 cases with lung metastasis,1 case with bone metastasis and 1 case with spleen metastasis.The 5-year overall survival rate and tumor free survival rate of the 157 patients were 90.9%and 80.8%,respectively.Conclusion The stylized laparoscopic hemicolectomy for left colon cancer is safe and feasible.