结直肠癌肝转移同期腹腔镜与开腹手术的疗效比较:倾向性评分匹配分析  

Comparison of simultaneous laparoscopic surgery versus open surgery for colorectal cancer liver metastases:a propensity score matching analysis

作　　者：叶星照[1] 毛瑞波 陈熙益 蒋飞照[1] 李绍堂[1] Ye Xing-zhao;Mao Rui-bo;Chen Xi-yi;Jiang Fei-zhao;LI Shao-tang(Department of Colorectal Surgery,the First Affiliated Hospital of Wenzhou Medical University;Department of Thoracic Surgery,the Second Affiliated Hospital of Wenzhou Medical University,Wenzhou,Zhejiang 325000,China)

机构地区：[1]温州医科大学附属第一医院结直肠肛门外科 [2]温州医科大学附属第二医院胸外科,浙江温州325000

出　　处：《肝胆胰外科杂志》2020年第12期709-714,共6页Journal of Hepatopancreatobiliary Surgery

基　　金：温州市科技计划项目(Y20180085)。

摘　　要：目的比较倾向性评分匹配后的结直肠癌肝转移患者同期腹腔镜手术与开腹手术的安全性及近期疗效。方法回顾性分析2011年1月至2020年8月温州医科大学附属第一医院收治的79例行一期联合切除手术的结直肠癌肝转移(CRLM)患者的临床资料。采用倾向性评分匹配方法将开腹组患者与腔镜组进行匹配,每组纳入24例,比较两组围手术期的临床指标。结果两组患者并发症发生率、围手术期病死率、二次手术率、术中输血率、开始流质饮食时间、腹腔引流管留置时间、术后住院时间和住院费用差异均无统计学意义(P>0.05)。相比开腹组,腔镜组手术时间更长[(274±57)min vs(190±53)min,P<0.001],术后肛门排气时间更短[(4(2~11)d vs 5(3~15)d,P=0.005],术后第1天白细胞计数更低[(10.3±3.7)×10^9/L vs(12.4±3.5)×10^9/L,P=0.047]。结论结直肠癌肝转移同期腹腔镜手术是安全、可行的,与开腹手术相比,具有一定的临床优势。Objective To compare the safety and short-term efficacy of simultaneous laparoscopic surgery and open surgery in propensity score matched patients with colorectal cancer liver metastases(CRLM).Methods Clinical data of 79 CRLM patients underwent simultaneous resection of colorectal cancer and liver metastases at the First Affiliated Hospital of Wenzhou Medical University from Jan.2011 to Aug.2020 were retrospectively analyzed.The propensity score matching method was employed to match the patients of open group with those of laparoscopic,and 24 cases were included in each group.Perioperative clinical indicators were compared between the two groups.Results There were no statistical significant differences between the two groups in complication incidence rate,perioperative mortality rate,secondary surgery rate,intraoperative blood transfusion rate,liquid food intake time,abdominal drainage tube removal time,postoperative hospitalization time or hospitalization expenses(P>0.05).Compared with the open group,the operation time in the laparoscopic group was longer[(274±57)min vs(190±53)min,P<0.001],the postoperative anal exhaust time was shorter[4(2~11)d vs 5(3~15)d,P=0.005],and the white blood cell count on the first day after surgery was less[(10.3±3.7)×10^9/L vs(12.4±3.5)×10^9/L,P=0.047].Conclusion For CRLM patients,simultaneous laparoscopic resection of the colorectal cancer and liver metastases is safe and feasible.Compared with simultaneous open surgery,which has certain clinical advantages.

关 键 词：结直肠癌肝转移 结直肠切除术 肝切除术 腹腔镜手术 倾向性评分匹配 

分 类 号：R735.3[医药卫生—肿瘤] R735.7[医药卫生—临床医学]