腹腔镜与同期开腹直肠癌根治术后肿瘤学结果对比研究  

Comparative Study on Oncologic Results of Laparoscopic Versus Open Radical Resection for Patients with Rectal Cancer

作　　者：梁耀泽[1] 余江[1] 张策[1] 王亚楠[1] 胡彦锋[1] 甄莉[1] 程侠[1] 朱正鹏[1] 李国新[1] 

机构地区：[1]南方医科大学南方医院普外科,广州510515

出　　处：《中国普外基础与临床杂志》2010年第6期591-595,共5页Chinese Journal of Bases and Clinics In General Surgery

基　　金：广东省科技计划项目(项目编号:2006B12901006);广州市科技攻关项目(项目编号:2006Z3-E0571)~~

摘　　要：目的评价腹腔镜和同期开腹直肠癌根治术在肿瘤学结果方面的差异。方法分析南方医院2003年1月至2008年12月期间520例行直肠癌根治术的TNMⅠ～Ⅲ期病例的临床随访资料,其中腹腔镜组186例,开腹组334例,对2组术后复发、生存等肿瘤学结果进行比较。结果腹腔镜组和开腹组基本临床病理特征及辅助治疗情况具有均衡可比性。2组平均随访30.3个月。腹腔镜组与开腹组比较,3年累积生存率为83%比80%,远处转移率为12.5%比15.6%,戳孔/切口癌转移率为0.6%比0,差异均无统计学意义(P>0.05);局部复发率为4.8%比10.7%,3年累积无病生存率为81%比68%,差异均具有统计学意义(P<0.05)。生存分析显示,累积生存率2组差异无统计学意义(P=0.142),而累积无病生存率腹腔镜组则显著高于开腹组(P=0.010)。Ⅰ或Ⅱ期病例中2组局部复发率、远处转移率、累积生存率及累积无病生存率的差异均无统计学意义(P>0.05);Ⅲ期病例远处转移率、累积生存率差异亦无统计学意义(P>0.05),但Ⅲ期病例腹腔镜组局部复发率显著低于开腹组(6.8%比17.7%,P=0.047),累积无病生存率则显著高于开腹组(P=0.045)。结论腹腔镜直肠癌根治术可以达到甚至优于同期开腹根治术的肿瘤学结果 ,提示针对直肠癌的腹腔镜外科前瞻性随机对照研究的可行性和必要性。Objective To compare the oncologic results between laparoscopic and open approach for the treatment of rectal cancer.Methods Five hundred and twenty patients with rectal cancer from Jan.2003 to Dec.2008 were non-randomly divided into laparoscopic（LS）and open surgery（OS）group.Local recurrence,distant metastasis and survival rate were compared between two groups.Results One hundred and eighty-six cases received laparoscopic resection and 334 cases received open operation.There were no statistically significant differences（SSD）of demographic data between two groups（P〉0.05）.Mean follow-up was 30.3 months.No SSD was observed in 3-year cumulative survival rate（83% in LS and 80% in OS,P=0.549）,distant metastasis rate（12.5% in LS and 15.6% in OS,P=0.368）,incidence of incision seeding（0.6% in LS and 0 in OS,P=0.189）,or cumulative survival（P=0.142）.The differences of local recurrences rate（4.8% in LS and 10.7% in OS,P=0.028）,3-year cumulative disease-free survival rate（81% in LS and 68% in OS,P=0.009）,and cumulative disease-free survival（P=0.010）between two groups were statistical significant.The differences of cumulative survival,cumulative disease-free survival,local recurrences,and distant metastasis according to the TNM stageⅠ or Ⅱ between two groups were not statistical significant.The differences of cumulative disease-free survival and local recurrences according to the TNM stage Ⅲ reached statistical significance（P=0.045 and P=0.047,respectively）.Conclusion Oncologic results of laparoscopic resection are similar to those of open resection for rectal carcinoma.

关 键 词：直肠癌 腹腔镜 生存分析 

分 类 号：R735.3[医药卫生—肿瘤]