大肠癌合并肝脏转移患者的同期微创手术疗效分析

目的探讨同期行腹腔镜大肠癌根治术联合肝大部切除术治疗同时性大肠癌合并肝转移(SCLM)的疗效和安全性。方法回顾性分析2010年1月至2015年10月收治的58例SCLM患者资料,根据肝切除术的手术方案分为A组(同期微创组,腹腔镜大肠癌根治术联合腹腔镜肝大部切除术,n=30)和B组(同期微创联合开腹组,腹腔镜大肠癌根治术联合开腹肝大部切除术,n=28)。采用SPSS 19.0统计学软件进行统计分析,术后分期及并发症等采用χ2检验;术中、术后恢复资料以均数±标准差表示,比较用t检验;采用Kaplan-Meier法计算两组1、2、3年的总生存率。以P0.05视为差异有统计学意义。结果 A组的肝转移灶的数目、最大直径、术前CEA等均显著少于/低于B组(P0.05)。两组的术中及术后资料比较差异无统计学意义(P0.05)。A组、B组的并发症发生率分别为36.7%、53.6%,所有并发症在给予对症处理后均缓解或痊愈。A组、B组术后1、2、3年的总生存率分别为100%、100%、93.3%和92.9%、85.7%、75.6%,两组比较差异均无统计学意义(P0.05)。结论对SCLM而言,全腹腔镜下行大肠癌根治术及肝大部切除术是安全可行的,在围手术期安全性与远期生存状况方面与腹腔镜大肠癌根治术联合开腹肝大部切除术相近。

Effect of simultaneous laparoscopy on patients with synchronous colorectal liver metastases

Objective To investigate the clinical effect and safety of laparoscopic colorectal radical resection combined with simultaneous laparoscopic major hepatectomy for synchronous colorectal liver metastases ( SCLM). Methods Clinical data of 58 patients with SCLM between January 2010 and October 2015 in our hospital were retrospective analyzed , and they were divided into the group A (simultaneous laparoscopy group, laparoscopic colorectal radical resection combined with simultaneous laparoscopic major hepatectomy, n =30) and group B (simultaneous laparoscopy combined with open group , laparoscopic colorectal radical resection combined with simultaneous open major hepatectomy , n =28).SPSS 19.0 statistical software was performed to statistical analysis .Chi square test was used to compare the postoperative stage and complications.Intraoperative and postoperative recovery data were showed in mean ± standard deviation, and t test was used for their comparison.Kaplan-Meier method was performed to calculate the 1-, 2-, 3-year overall survival in two groups .P <0.05 was considered as statistically significant difference. Results Number, maximum diameter of liver metastases and preoperative CEA in group A were significantly lower than that in group B (P <0.05).There were no significant differences in intraoperative and postoperative data between two groups (P >0.05).The incidences of complication in group A and B were 36.7% and 53.6% respectively, and all complications were cured or alleviated .The 1-, 2-, 3-year overall survival rates in group A and B were 100%, 100%, 93.3% and 92.9%, 85.7%, 75.6% respectively, and there were no statistically significant differences between them ( P >0.05). Conclusions Laparoscopic colorectal radical resection combined with simultaneous laparoscopic major hepatectomy is safe and feasible for SCLM, and its perioperative safety and long -term survival conditions were close to that of laparoscopic colorectal radical resection combined with simultaneous open major hepatectomy .