腹腔镜辅助结肠次全切除术治疗同时性多原发结直肠癌的应用体会  

Laparoscopic-assisted subtotal colectomy for synchronous multiple primary colorectal cancer

作　　者：顾纪明[1,2] 蒋晖 金留根 钱程佳 陈柏 谢立飞 Jiming Gu;Hui Jiang;Liugen Jin;Chengjia Qian;Bai Chen;Lifei Xie(Department of Gastrointestinal Surgery,Affiliated Hospital of Jiangnan University,Wuxi 214122,China;Department of General Surgery,the First Affiliated Hospital of Soochow University,Suzhou 215006,China)

机构地区：[1]江南大学附属医院胃肠外科,无锡214122 [2]苏州大学附属第一医院普通外科,215006

出　　处：《中华结直肠疾病电子杂志》2024年第2期153-157,共5页Chinese Journal of Colorectal Diseases(Electronic Edition)

摘　　要：目的探讨腹腔镜辅助结肠次全切除术治疗间隔较远或横跨一个以上肠段同时性多原发结直肠癌(sMPCC)的安全性和疗效。方法回顾性分析2013年1月~2021年6月江南大学附属医院胃肠外科团队行腹腔镜手术治疗的27例sMPCC患者临床资料。按手术方式分为两组:观察组(n=16)行腹腔镜辅助结肠次全切除术,对照组(n=11)行腹腔镜辅助分段结直肠癌根治术。观察手术情况和术后疗效。结果27例患者均手术成功,无中转开腹,两组术后均无严重并发症。两组手术时间(t=-0.154,P>0.05)、术中出血量(Z=-0.919,P=0.358)、肠功能恢复时间(t=-1.268,P>0.05)、手术相关并发症发生率比较差异均无统计学意义(P>0.05)。观察组术后6个月排便次数多于对照组,差异有统计学意义(t=4.159,P=0.000)。观察组淋巴结清扫数目多于对照组,差异有统计学意义(t=3.202,P<0.01)。观察组手术费用少于对照组,差异有统计学意义(t=-3.811,P<0.01)。术后随访12~24个月,两组病例均无吻合口复发,排便状况均良好。结论腹腔镜辅助结肠次全切除术式用于跨肠段sMPCC安全可行,近期疗效确切,在淋巴结清扫数目及卫生经济学方面有一定的优势。ObjectivesTo investigate the safety and efficacy of laparoscopic-assisted subtotal colectomy in the treatment of synchronous multiple primary colorectal cancer (sMPCC) with distant intervals or spanning more than one colon segment.MethodsThis was a retrospective analysis of 27 patients with synchronous multiple primary colorectal cancer receiving laparoscopic surgery at Department of Gastrointestinal Surgery, Affiliated Hospital of Jiangnan University, between January 2013 and June 2021. Patients were divided into treatment group (n=16, receiving laparoscopic-assisted subtotal colectomy) and control group (n=11, receiving laparoscopic-assisted segmented radical resection of colorectal cancer). The operation data and postoperative curative effect were recorded.ResultsSurgeries were uneventful in 27 cases without conversion to laparotomy, and there were no serious complications after operation in both groups. There was no significant difference between the two groups in duration of surgery (t=-0.154, P>0.05), intraoperative blood loss (Z=-0.919, P=0.358), time to intestinal function recovery (t=-1.268, P>0.05), and incidence of surgery-related complications. The frequency of defecation 6 months after operation in the observation group was higher than that in the control group, and the difference was statistically significant (t=4.159, P=0.000). The number of lymph node dissection in treatment group was higher than that in the control group (t=3.202, P<0.01). The operation cost in the treatment group was less than that in the control group (t=-3.811, P<0.01), and the difference was statistically significant. No anastomotic recurrence occurred in the two groups at the follow-up of 12~24 months, and the bowel movements were in good condition.ConclusionLaparoscopic-assisted subtotal colectomy is safe and effective in treating trans-segment synchronous multiple primary colorectal cancer, its short-term outcome is satisfactory, the procedure has demonstrated benefits in lymph node dissection and reduced operation cost.

关 键 词：结直肠肿瘤 腹腔镜 结肠次全切除术 多原发结直肠癌 安全性 疗效 

分 类 号：R735.37[医药卫生—肿瘤]