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腹腔镜术在结直肠癌伴肝转移中的安全性和有效性评价
作者:刘洁1  付靓1  史志涛2  姜德2 
单位:1. 新疆医科大学附属中医医院肛肠科, 新疆 乌鲁木齐 830000;
2. 新疆医科大学附属中医医院普外科, 新疆 乌鲁木齐 830000
关键词:腹腔镜术 开腹术 结直肠癌伴肝转移 安全性 有效性 生存率 
分类号:R735.3+5;R735.3+7
出版年·卷·期(页码):2018·46·第八期(843-847)
摘要:

目的:探讨腹腔镜术在结直肠癌伴肝转移患者中的安全性、有效性。方法:选择2015年6月-2017年8月科室收治的结直肠癌伴肝转移患者66例,根据手术方法不同将其分为开腹手术组(n=33例)和腹腔镜组(n=33例)。开腹手术组采用开腹手术治疗,腹腔镜组采用腹腔镜手术治疗,采用WHO肿瘤效果标准对两组疗效率进行评估;记录两组手术时间、术中出血量、肛门排气时间、住院时间及术后开始化疗时间;记录并统计两组术后切口感染、腹腔脓肿、肠梗阻及消化道出血发生率;记录并比较两组术后1、2及3年的生存率。结果:腹腔镜组疗效率为33.33%(28/33),高于开腹手术组21.21%(21/33)(P<0.05);两组术后开始化疗时间无统计学意义(P<0.05);腹腔镜组术中出血量、术后肛门排气及住院时间,均短(少)于开腹手术组(P<0.05),腹腔镜组手术时间长于开腹手术组(P<0.05);腹腔镜组术后切口感染、腹腔脓肿、肠梗阻及消化道出血等总并发症发生率低于开腹手术组(P<0.05);腹腔镜组术后1、2及3年生存率分别为81.82%(27/33)、69.70%(23/33)和54.55%(18/33),开腹手术组分别为72.73%(24/33)、57.58%(19/33)和30.30%(10/33),与开腹手术组比,腹腔镜组3年存活率明显增高(P<0.05)。结论:将腹腔镜手术用于结直肠癌伴肝转移患者中有助于提高临床疗效及提高患者生存率,具有手术创伤小和术后恢复快等特点,值得推广应用。

Objective:To investigate the safety and effectiveness of laparoscopy in patients with colorectal cancer and liver metastasis. Methods:66 colorectal cancer with liver metastasis patients admitted into our department from June 2015 to August 2017 were divided into 2 groups according to the surgical method:laparotomy group (n=33) and laparoscopic group (n=33). The patients in the laparotomy group underwent open surgery, the patients in the laparoscopic group underwent laparoscopy. The therapeutic effect of two groups was evaluated by WHO's tumor effect standard. The operation time, blood loss, anal exhaust time, hospitalization time and the time of postoperative chemotherapy were recorded. The incision infection, abdominal abscess, intestinal obstruction and gastrointestinal bleeding were recorded and statistically analyzed. The patients were followed up for 5 years. The cumulative postoperative survival rate of 1, 2 and 3 years, clinical efficacy, survival rate and safety of the two groups were compared. Results:The response rate of laparoscopic group was 33.33% (28/33), higher than 21.21%(21/33) of the laparotomy group (P<0.05). There was no significant differences between 2 groups in postoperative chemotherapy (P<0.05); Postoperative anal exhaust and hospital stay were shorter (less) in the laparotomy group (P<0.05),laparoscopic operation time was longer than that in the laparotomy group (P<0.05). while laparoscopic incision infection, the incidences of the abdominal abscess, intestinal obstruction and gastrointestinal bleeding were significantly lower in the laparoscopic group than those of the laparotomy group (P<0.05). The 1-year, 2-year and 3-year survival rates of the laparoscopic group were 81.82% (27/33) 69.70% (23/33) and 54.55%(18/33), respectively, which were significantly higher than those in the open surgery group 72.73%(24/33), 57.58%(19/33) and 30.30%(10/33) respectively(P<0.05). Compared with the laparotomy group, the survival rate of 3 years in the laparoscopic group were significantly higher (P<0.05). Conclusions:Laparoscopic surgery in patients with colorectal cancer and liver metastasis is helpful to improve the clinical curative effect, having the advantages of less traumatic operation and quick recovery after operation. It is helpful to improve the survival rate of patients and is worth popularizing and applying.

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