腹腔镜结肠癌根治术对早期结肠癌术后近期复发的影响  

Effect of short-term recurrence of early stage colon cancer by laparoscopic colon cancer radical

作　　者：沈乃营 张天政 刘昌[2] 何盟国 郑康 王智翔 

机构地区：[1]核工业二一五医院肝胆外科,陕西咸阳712000 [2]西安交通大学第一附属医院肝胆外科,陕西西安711000

出　　处：《中国现代普通外科进展》2017年第6期435-439,共5页Chinese Journal of Current Advances in General Surgery

基　　金：国家自然科学基金资助项目(81472247)

摘　　要：目的:对比腹腔镜和开腹结肠癌根治术对早期结肠癌患者术后近期复发的影响,确定手术的安全性和有效性。方法:纳入2010年1月—2012年10月行腹腔镜结肠癌根治术患者62例和开腹结肠癌根治术患者83例作为队列研究,通过随访术后结局以及鸟苷酸环化酶C(GCC)-mRNA和癌胚抗原(CEA)水平进行分析,比较腹腔镜和开腹手术对结肠癌复发的影响。结果:腹腔镜组和开腹组患者入院时年龄、性别、体重指数、肿瘤大小、分期、评分、病理类型以及切除范围等差异均无统计学意义(P>0.05)。两组术后3年的复发率差异无统计学意义(P>0.05),但术后1年腹腔镜组较开腹组复发率明显低(3.2%比14.5%),差异有统计学意义(P<0.05);两组患者术后总生存率和死亡率差异无统计学意义(P>0.05),但术后1年无瘤生存率腹腔镜组明显高于开腹组(93.5%比81.3%),差异有统计学意义(P<0.05)。患者术后早期(术后6个月)GCC-mRNA和CEA阳性率腹腔镜组显著低于开腹组。对患者术后1年的结肠癌复发率进行单因素和多因素分析发现,腹腔镜结肠癌根治术较开腹手术在术后1年内能明显降低结肠癌的复发(P<0.05)。另外,分期及氨基水杨酸类药物的应用都是术后复发的危险因素(P<0.05)。结论:腹腔镜结肠癌根治术是一种安全的手术方式,较开腹手术能显著降低患者近期结肠癌复发率。Objective： Comparing the influence of colon cancer recurrence of laparoscopic and open operation to evaluate the safety and validity of operation. Methods： The cohort study includes 62 cases of laparoscopic and 83 cases of open colon cancer radical surgery from January 2010 to October 2012. The research aimed at comparing the effects of laparoscopic and open surgery for colon cancer recurrence by analyzing postoperative follow-up ending and GCC - mRNA ＆ CEA. Re. suits： There have no obvious differences in age, sex ,BMI, tumor size, stage, grade, pathological types and resection range between laparoscopy and open group（P〉0.05）. Postoperative 3-years recurrence of two groups have no difference （P〉0.05）, but 1-year recurrence rate of laparoscopic was obviously lower than open operation （3.2% vs 14.5%, P〈0.05）. There have no obvious differences of postoperative overall survival rate and mortality（P〉0.05）, but 1 -year disease-free survival rate of laparoscopic group was obviously higher than laparotomy group （93.5% vs 81.3%, P〈0.05）. The post- operative GCC-mRNA and CEA positive rate of laparoscopic was significantly lower than laparotomy group. Univariable and Multivariable analysis reveals that laparoscopic colorectal cancer radical can obviously reduce the cancer recurrence within 1 year （P〈0.05）. Addition,stage, aspirin and other amino acid drugs are independent risk factors of postoperative recurrence （P〈0.05）. Conclusion： Laparoscopic colon cancer radical surgery is a safe and effective operation and can reduce short-term recurrence of colorectal cancer compared to open surgery.

关 键 词：腹腔镜结肠癌根治术 开腹结肠癌根治术 肿瘤复发 无瘤生存率 

分 类 号：R656.9[医药卫生—外科学]