单孔与三孔腹腔镜结肠直肠癌根治术的回顾性研究

Single-port and three-port laparoscopic radical resection in colorectal cancer: a retrospective study

目的:评价单孔腹腔镜根治术治疗结肠直肠癌的安全性、可行性及临床疗效。方法 :2017年1月至2017年12月,采取回顾性研究,上海交通大学医学院附属瑞金医院北院普外科结肠直肠癌病人分成单孔和三孔腹腔镜手术组,对比两组的手术时间、术中出血量、淋巴结检出数和术后并发症发生率,胃肠功能恢复时间、术后局部复发、远处转移。结果:78例中,单孔组40例,三孔组38例。单孔组中4例增加操作孔,1例中转开腹;三孔组3例增加操作孔。术中均无输尿管和阴道损伤,均未行造口。单孔组和三孔组手术时间分别为(106.38±30.21) min和(109.49±34.93) min,术中出血量为(59.62±11.93) mL和(42.63±6.62) mL,均无统计学差异。术后排气时间为(3.15±1.08) d和(3.97±1.03) d(P<0.01),疼痛VAS<Ⅰ级时间为(1.40±0.50) d和(4.11±0.89) d (P<0.01)。所有手术切缘均阴性,标本均达到完整切除要求,淋巴结检出数为(13.70±2.93)枚和(12.66±1.55)枚,无统计学差异。术后所有病例均未出现吻合口漏等严重并发症,单孔组切口感染1例。随访6~18个月,未见肿瘤复发或转移。结论:单孔腹腔镜结肠直肠癌手术能达到三孔腹腔镜手术同样的安全性和根治性,且术后胃肠功能恢复快,疼痛时间明显缩短。

Objective To evaluate the safety, feasibility and clinical efficacy of single-port laparoscopy in the treatment of colorectal cancer. Methods From January 2017 to December 2017, a retrospective study was conducted with patients diagnosed as colorectal cancer in Department of General Surgery Ruijin Hospital North Shanghai Jiao Tong Univer-sity School of Medicine. Patients were divided into single-port group and three-port group. The operative time, intraoperative blood loss, lymph node harvest, postoperative complication rate, gastrointestinal recovery, local recurrence, distant metastasis were compared between two groups. Results There were 78 patients with laparoscopic radical resection of colorectal cancer including 40 cases in single-port group and 38 cases in three-port group. Four patients added port and 1 patient converted to open surgery in single-port group. Three patients in three-port group added port without conversion to open events. There were no ureter or vaginal injuries and no colostomy procedure during operation. The operative time was(106.38±30.21) min and(109.49±34.93) min, and intraoperative blood loss(59.62±11.93) mL and(42.63±6.62) mL and single-port group and three-port group respectively without statistical difference. There was significant difference of postoperative evacuation time between 2 groups ((3.15±1.08) d vs(3.97±1.03) d(P<0.01))Mean time of pain score(VAS) reduced to less than levelⅠwas(1.40±0.50) d vs(4.11±0.89) d in 2 groups respectively(P<0.01). Surgical margins in all cases were negative and the specimens all met the requirements of complete resection. The number of lymph nodes detect-ed in 2 groups was(13.70±2.93) and(12.66±1.55) without statistical difference. There was no severer complication such as anastomotic leakage in all cases postoperatively, and 1 case with incision infection occurred in single-port group. No tumor recurrence or metastasis was observed during the period of follow-up from 6 to 18 month. Conclusions Single-port laparoscopic colorectal cancer surgery could be safe and radical same as three-port laparoscopic surgery with faster postoperative gastrointestinal recovery and shorter pain time.