3D腹腔镜结肠癌根治手术疗效分析及预后评价

Efficacy Analysis and Prognosis Evaluation of 3D Laparoscopic Radical Resection of Colon Cancer

目的探讨3D腹腔镜结肠癌根治手术疗效及安全性,分析Bmi-1和CDX-2表达与结肠癌临床病理特征及预后的关系。方法对比分析腹腔镜手术与开腹手术2组切口总长度、手术时间、术中失血量、清扫淋巴结数目、术后12 h疼痛评分、肠功能恢复时间及术后平均住院日7项指标;采用免疫组化EliVision TM plus两步法检测结肠癌组织Bmi-1和CDX-2的表达,分析其与患者年龄、瘤体大小、分化等级、淋巴结转移及5年内复发转移5项临床病理特征的相关性。结果腹腔镜组与开腹组比较,手术时间、清除淋巴结数目无显著差异,但切口总长度小,手术失血量少,术后12 h疼痛评分低,肠功能恢复快,术后平均住院日短。结肠癌组织Bmi-1和CDX-2阳性率分别为79.1%和64.2%。Bmi-1表达与年龄、瘤体大小、分化等级无关,在有淋巴结转移、5年内复发转移患者中其阳性率显著高于无淋巴结转移、5年内无复发转移者;CDX-2表达与年龄、瘤体大小无关,在低分化等级、有淋巴结转移、5年内复发转移患者中其阳性率显著低于(高+中)分化、无淋巴结转移、5年内无复发转移者。Bmi-1和CDX-2表达呈负相关性。结论3D腹腔镜结肠癌手术具有满意的根治效果和安全性,癌组织Bmi-1高表达、CDX-2低表达预示术后易发生复发转移,患者预后不良。

Objective To investigate the efficacy and safety of three-dimensional(3D)laparoscopic radical resection for colon cancer,and to analyze the relationship between the expression of Bmi-1 and CDX-2 and the clinicopathologic characteristics as well as the prognosis of colon cancer.Methods A comparative analysis was conducted between two groups,one undergoing laparoscopic surgery and the other open surgery.Seven key indicators were assessed,including total incision length,surgical duration,intraoperative blood loss,number of lymph nodes cleared,pain score at 12 hours post-operation,time to intestinal function recovery,and average length of postoperative hospital stay.Immunohistochemistry using the EliVision TM plus two-step method was employed to detect the expression of Bmi-1 and CDX-2 in colon cancer tissues.The correlation between their expression and five clinicopathologic characteristics(patient age,tumor size,differentiation grade,lymph node metastasis,and recurrence within 5 years)was analyzed.Results There were no significant differences in surgical duration or the number of lymph nodes cleared between the laparoscopic group and the open surgery group.However,the laparoscopic group exhibited shorter total incision length,lower intraoperative blood loss,milder pain score at 12 hours post-operation,quicker recovery of intestinal function,and shorter postoperative hospital stay.The positive rates of Bmi-1 and CDX-2 in colon cancer tissues were 79.1% and 64.2%,respectively.Bmi-1 expression was not correlated with age,tumor size,or differentiation grade.Nevertheless,among patients with lymph node metastasis and recurrence within five years,the positive rate of Bmi-1 was significantly higher compared to those without lymph node metastasis or recurrence within five years.CDX-2 expression was unrelated to age or tumor size.However,among patients with low differentiation grade,lymph node metastasis,and recurrence within five years,the positive rate of CDX-2 was significantly lower compared to those with high or moderate differentiation,no lymph node metastasis,or no recurrence within five years.There was a negative correlation between Bmi-1 and CDX-2 expression.Conclusion 3D laparoscopic colon cancer surgery demonstrates satisfactory radical results and safety.High expression of Bmi-1 and low expression of CDX-2 in cancer tissues predict a higher likelihood of recurrence and metastasis post-surgery,indicating poorer patient prognosis.