腹腔镜和开腹肝切除治疗结直肠癌肝转移的临床观察
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摘要
目的:探讨采取腹腔镜肝切除及开腹肝切除治疗结直肠癌肝转移患者的临床疗效。方法:2015年1月—2016年12月66例结直肠癌肝转移患者随机分为对照组(开腹肝切除术治疗)与观察组(腹腔镜肝切除术治疗)各33例,对两组患者的手术相关指标、并发症发生情况及随访情况进行观察。结果:观察组手术时间略长于对照组(P>0.05),术中出血量、术后平均住院时间两组差异有统计学意义(P <0.05);并发症发生率、术前肝功能指标两组差异无统计学意义(P>0.05),术后3d时,观察组的总胆红素低于对照组(P <0.05),其余指标差异统计学意义(P>0.05);观察组平均随访31(6～42)月,对照组平均随访23.5(7～43)月,其中观察组复发20例(60.6%),有2例(6.1%)分别于随访至22个月、30个月时死亡。对照组复发23例(69.7%),有2例(6.1%)在随访至第20个月、18个月时死亡,两组复发率、死亡率,差异无统计学意义(P>0.05)。结论:结直肠癌肝转移采取腹腔镜切除治疗,平均住院时间、术中出血量及术后肝功能恢复优于开腹切除术,在长期生存率及肿瘤复发上,两种手术无太大差别。
Objective:To investigate the clinical efficacy of laparoscopic hepatectomy and open hepatectomy for colorectal cancer patients with liver metastases.Methods:66 cases of livermetastases from colorectal cancer received in our hospital from January 2015 to December 2016 were randomly divided into control group(n=33,open hepatectomy) and observation group(n=33,laparoscopic hepatectomy),and the related indexes,complications and follow-up of the two groups of patients were observed.Results:The operation time of the observation group was slightly longer than that of the control group,the difference was not statistically significant(P >0.05).The amount of bleeding during the operation was less than that of the control group,the difference was statistically significant(P <0.05).The average length of stay in the observation group was less than that in the control group(P <0.05).There was no significant difference in the incidence of complications between the two groups(P >0.05).There was no statistical difference between the two groups before operation(P >0.05).The total bilirubin in the observation group was lower than that of the control group at 3 d after operation(P <0.05),and the other indexes were similar,and there was no statistical significance between the groups(P >0.05).The average follow-up of the observation group was 31(6～42) months,the average follow-up of the control group was 23.5(7～43) months,the two groups had no significant difference(P >0.05).During the follow-up period,in the observation group,20 cases(60.6%) recurred,in the control group,13 cases(39.4%) did not relapse,23 cases(69.7%) recurred,and 10 cases(30.3%) did not relapse.In the observation group,2 cases(6.1%) died and died at 22 months and 30 months respectively.In the control group,2 cases(6.1%) died at 20 months and 18 months,and the recurrence rate and mortality rate of the two groups were statistically significant(P >0.05).Conclusion:Laparoscopic dry resection for the treatment of liver metastasis of colorectal cancer,the average number of days of hospitalization,the amount of intraoperative bleeding and the recovery of liver function were better than that of laparotomy.There is no significant difference between the two operations on the long-term survival rate and the recurrence of the tumor.
Objective:To investigate the clinical efficacy of laparoscopic hepatectomy and open hepatectomy for colorectal cancer patients with liver metastases.Methods:66 cases of livermetastases from colorectal cancer received in our hospital from January 2015 to December 2016 were randomly divided into control group(n=33,open hepatectomy) and observation group(n=33,laparoscopic hepatectomy),and the related indexes,complications and follow-up of the two groups of patients were observed.Results:The operation time of the observation group was slightly longer than that of the control group,the difference was not statistically significant(P >0.05).The amount of bleeding during the operation was less than that of the control group,the difference was statistically significant(P <0.05).The average length of stay in the observation group was less than that in the control group(P <0.05).There was no significant difference in the incidence of complications between the two groups(P >0.05).There was no statistical difference between the two groups before operation(P >0.05).The total bilirubin in the observation group was lower than that of the control group at 3 d after operation(P <0.05),and the other indexes were similar,and there was no statistical significance between the groups(P >0.05).The average follow-up of the observation group was 31(6～42) months,the average follow-up of the control group was 23.5(7～43) months,the two groups had no significant difference(P >0.05).During the follow-up period,in the observation group,20 cases(60.6%) recurred,in the control group,13 cases(39.4%) did not relapse,23 cases(69.7%) recurred,and 10 cases(30.3%) did not relapse.In the observation group,2 cases(6.1%) died and died at 22 months and 30 months respectively.In the control group,2 cases(6.1%) died at 20 months and 18 months,and the recurrence rate and mortality rate of the two groups were statistically significant(P >0.05).Conclusion:Laparoscopic dry resection for the treatment of liver metastasis of colorectal cancer,the average number of days of hospitalization,the amount of intraoperative bleeding and the recovery of liver function were better than that of laparotomy.There is no significant difference between the two operations on the long-term survival rate and the recurrence of the tumor.
引文
[1]李晓萍,高章萍,于建萍,等.经腹腔镜超声引导下直肠癌肝转移灶射频消融治疗后护理[J].武警医学,2014,25(4):410-412.
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[3]姚宏伟,姚响芸,孙涛,等.腹腔镜结直肠癌根治性切除联合同期腹腔镜或开腹肝大部切除术治疗同时性结直肠癌肝转移的疗效分析[J].中华消化外科杂志,2016,15(2):128-134.
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[6]秦新裕.对“经腹经肛全直肠系膜切除联合肝转移灶切除术治疗同时性低位直肠癌肝转移”的点评[J].中华消化外科杂志,2016,15(2):127.
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[8]惠菲菲,刘凯,杨家和,等.同时性结直肠癌肝转移结直肠癌组织中Kiss-1蛋白和基质金属蛋白酶9蛋白的表达及意义[J].中华消化外科杂志,2016,15(2):153-160.
[9]孙庆章.新辅助治疗下保留左结肠动脉的腹腔镜直肠癌前切除术31例临床观察[J].中国现代普通外科进展,2015,18(6):477-480.
[10]王鸿,陈伟平.腹腔镜和开腹手术治疗结直肠癌伴发肝转移患者的临床疗效研究分析[J].浙江创伤外科,2016,21(3):479-480.
[11]国士刚,李国明.腹腔镜下结直肠癌切除联合肝转移瘤射频消融术与传统开腹手术的疗效对比研究[J].中国医刊,2017,52(1):56-59.
[12]黄勇波,张成雷,洪新凯,等.无腹部辅助切口腹腔镜改良经肛门结肠肛管吻合术治疗超低位直肠癌的临床疗效[J].中华胃肠外科杂志,2017,20(1):105-106.
[13]付文政,张春泽,孙轶,等.腹腔镜经括约肌间切除治疗超低位直肠癌的优势及技术要点[J].中华结直肠疾病电子杂志,2017,6(1):32-36.
[2]姚宏伟,修典荣,付卫,等.腹腔镜手术治疗可切除的结直肠癌伴肝转移的前瞻性病例系列研究[J].中华外科杂志,2014,52(12):919-923.
[3]姚宏伟,姚响芸,孙涛,等.腹腔镜结直肠癌根治性切除联合同期腹腔镜或开腹肝大部切除术治疗同时性结直肠癌肝转移的疗效分析[J].中华消化外科杂志,2016,15(2):128-134.
[4]沈荐,李敏哲,杜燕夫,等.腹腔镜直肠癌前切除术中保留左结肠动脉与否的临床对照研究[J].中国微创外科杂志,2014,20(1):22-24,28.
[5]胡立群,李宁红,吴炜嘉,等.结直肠癌肝转移腹腔镜手术对机体炎症和免疫功能的影响[J].临床和实验医学杂志,2016,15(24):2414-2417.
[6]秦新裕.对“经腹经肛全直肠系膜切除联合肝转移灶切除术治疗同时性低位直肠癌肝转移”的点评[J].中华消化外科杂志,2016,15(2):127.
[7]李苏明,何志威,李美连,等.腹腔镜下全直肠系膜切除联合肛门内括约肌切除治疗超低位直肠癌临床研究[J].黑龙江医学,2017,41(9):824-826.
[8]惠菲菲,刘凯,杨家和,等.同时性结直肠癌肝转移结直肠癌组织中Kiss-1蛋白和基质金属蛋白酶9蛋白的表达及意义[J].中华消化外科杂志,2016,15(2):153-160.
[9]孙庆章.新辅助治疗下保留左结肠动脉的腹腔镜直肠癌前切除术31例临床观察[J].中国现代普通外科进展,2015,18(6):477-480.
[10]王鸿,陈伟平.腹腔镜和开腹手术治疗结直肠癌伴发肝转移患者的临床疗效研究分析[J].浙江创伤外科,2016,21(3):479-480.
[11]国士刚,李国明.腹腔镜下结直肠癌切除联合肝转移瘤射频消融术与传统开腹手术的疗效对比研究[J].中国医刊,2017,52(1):56-59.
[12]黄勇波,张成雷,洪新凯,等.无腹部辅助切口腹腔镜改良经肛门结肠肛管吻合术治疗超低位直肠癌的临床疗效[J].中华胃肠外科杂志,2017,20(1):105-106.
[13]付文政,张春泽,孙轶,等.腹腔镜经括约肌间切除治疗超低位直肠癌的优势及技术要点[J].中华结直肠疾病电子杂志,2017,6(1):32-36.