腹腔镜手术对结肠癌患者腹腔脱落癌细胞及预后的影响  

Effect of laparoscopic colectomy on exfoliated cancer cells in peritoneal cavity and prognosis for patients with colon cancer

作　　者：刘彦[1] 陶凯雄[1] 卢晓明[1] 王琳芳[1] 牛彦锋[1] 王国斌[1] 

机构地区：[1]华中科技大学同济医学院附属协和医院胃肠外科,武汉430022

出　　处：《中华胃肠外科杂志》2014年第1期56-59,共4页Chinese Journal of Gastrointestinal Surgery

基　　金：基金项目：湖北省卫生厅课题基金（2009232JX4B54）

摘　　要：目的探讨腹腔镜手术对结肠癌患者腹腔脱落癌细胞和术后复发转移的影响。方法经病理诊断为结肠癌患者159例，按患者自愿的方法分成腹腔镜手术组（腹腔镜组）和开腹手术组（开腹组）。采用细胞学方法检测肿瘤切除前后腹腔脱落癌细胞，比较两组病例在肿瘤切除前后腹腔脱落肿瘤细胞阳性率、术后复发转移率和3年生存率。结果腹腔镜组与开腹组患者肿瘤切除前腹腔脱落肿瘤细胞阳性率分别为12．2％（9／74）和15．3％（13／85），两组比较，差异无统计学意义（P=0．718）；肿瘤切除后则分别为20．3％（15／74）和30．6％（26／85），两组比较，差异也无统计学意义（P=0．138）。术后随访4～45月，术后3年腹腔镜组与开腹组患者局部复发率分别为13．6％（8／59）和8-8％（6／68）（P=0．455），远处转移率分别为11．9％（7／59）和17．6％（12／68）（P=0．416），两组比较差异无统计学意义；3年生存率则分别为79．7％和80．0％（P=0．998），差异亦无统计学意义。结论腹腔镜手术并未增加结肠癌患者术后复发转移的概率，术后3年生存率与开腹手术相当。Objective To assess the effect of laparoscopic colectomy on the exfoliated cancer cells in peritoneal cavity, recurrence and metastasis of patients with colonic carcinoma. Methods One hundred and fifty-nine patients with colonic cancer proven by colonoscopy and pathology were divided into two groups based on patient＇s preference： laparoscopic group（n=74） and open group（n=85）. The positive rate of exfoliated cancer cells in peritoneal cavity was compared by cytological detection before and after cancer resection. Recurrence, metastasis rate and 3-year survival were compared between the two groups. Results The positive rates of exfoliated cancer cells in peritoneal cavity were 12.2% （9/74） in the laparoscopic group and 15.3% （13/85） in the open group before cancer resection without significant difference （P=0.718） ; 20.3% （15/74） and 30.6% （26/85） after cancer resection without significant difference （P=0.138）. The follow-up ranged from 4 to 45 months. The 3-year local recurrence rates were 13.6%（8/59） and 8.8%（6/68）（P=0.455）, the 3-year distal metastasis rates were 11.9%（7/59） and 17.6%（12/68）（P=0.416） and the 3-year survival rates were 79.7% and 80.0% （P=0.998）, and the differences were not statistcally significant. Conclusion The laparoscopic operation does not increase the recurrence and metastasis rate and results in similar survival in patients with colonic cancer as compared to open procedure.

关 键 词：结肠肿瘤 脱落癌细胞 腹腔镜 外科手术 

分 类 号：R735.35[医药卫生—肿瘤]