腹腔镜与开腹手术治疗结肠脾曲癌的效果比较

Comparison of Laparoscopy and Laparotomy in the Treatment of Splenic Flexure Cancer

目的比较腹腔镜与开腹手术治疗结肠脾曲癌的短期与长期效果。方法回顾性分析2013年7月~2020年6月于笔者医院行胃肠外科手术的结肠脾曲癌患者108例,行腹腔镜手术48例纳入腔镜组,开腹手术60例纳入开腹组,比较两组患者术中情况、术后恢复情况、手术并发症以及无瘤生存率和总生存率;通过COX多因素回归分析,确定独立影响患者总生存率的危险因素。结果腔镜组手术时间长(P=0.015)、术中出血量少(P=0.007)、术后住院时间短(P=0.003),差异有统计学意义;两组R0切除率、淋巴结个数、排气及进食时间、尿管及引流管拔除时间、手术并发症比较,差异均无统计学意义(P均>0.05);总生存率(P=0.982)和无瘤生存率(P=0.841)比较,差异无统计学意义;黏液腺癌或印戒细胞癌、低分化或未分化、T 4分期、N 1或N 2分期、脉管或神经受侵犯是总生存率的独立危险因素。结论对于结肠脾曲癌,腹腔镜手术与传统开腹手术比较可取得更佳的短期疗效和相似的长期结果。

Objective To compare the short-term and long-term effects of laparoscopy and laparotomy for splenic flexure cancer.Methods A retrospective analysis of 108 patients with splenic flexure cancer treated in our hospital from July 2013 to June 2020 was made.48 patients who underwent laparoscopic surgery were included in group LAP,and 60 patients who underwent laparotomy were included in group OPEN.The intraoperative condition,postoperative recovery,operative complications,disease-free survival and overall survival were compared between the two groups.The independent risk factors affecting the OS were determined by cox multivariate regression analysis.Results Compared with group OPEN,group LAP had longer operation time(P=0.015),less intraoperative blood loss(P=0.007)and shorter postoperative hospital stay(P=0.003),and the differences were statistically significant.There were no significant difference in R0 resection rate,number of lymph nodes,flatus time,first feeding time,catheter removal time and drainage tube removal time between the two groups(all P>0.05).There was no significant difference in the incidence of operative complications between the two groups(P=0.375),and there was no significant difference in OS(P=0.982)and DFS(P=0.841).Mucinous adenocarcinoma or signet ring cell carcinoma,poorly differentiated or undifferentiated,T 4,N 1 or N 2,vascular or nerve invasion were independent risk factors for OS.Conclusion For splenic flexure cancer,laparoscopic surgery can achieve better short-term efficacy and similar long-term results than open surgery.