腹腔镜直肠癌根治术的研究进展

随着腹腔镜直肠癌根治手术的改进,其应用也越来越广泛,其手术的安全性、可行性、远期疗效及根治性也逐渐得到认可。该文对其研究进展作一综述。     

腹腔镜直肠癌根治术中转开腹原因分析

目的分析腹腔镜直肠癌根治术中转开腹的各种原因。方法回顾分析该院于2005-01—2011-11共行腹腔镜直肠癌根治术64例的临床资料。结果中转开腹10例,中转开腹率为15．6％。中转开腹原因：3例严重粘连致分离中造成出血,1例肿瘤浸润前列腺,1例肿瘤浸润阴道壁,1例横断肠管时输尿管亦被横断,1例肠系膜下静脉大出血,1例肠系膜下动脉大出血,2例损伤左侧髂内静脉出血较多。结论腹腔镜直肠癌根治术应严格掌握手术适应证,术中一旦遇到难以控制的出血、损伤、解剖不清的粘连应立即行中转开腹手术。     

老年直肠癌患者行腹腔镜与开腹根治术的临床对比

目的探讨腹腔镜与开腹直肠癌根治术治疗老年人直肠癌的疗效。方法收集70岁以上直肠癌患者132例,腔镜组(LR组)54例,开腹组(OR组)78例,两组进行比较。结果两组均无死亡病例。术中出血量、排气时间、进食时间、镇痛药使用时间、SIRS持续时间及术后住院时间LR组明显低于OR组(P<0.01),LR组留置尿管时间及切口感染少于OR组(P<0.05)。手术时间、淋巴结清扫数目、吻合口瘘、肠梗阻、尿潴留均无统计学意义(P>0.05)。结论腹腔镜直肠癌根治术治疗老年直肠癌是安全有效的,与开腹手术对比,老年人获益是明显的。     

腹腔镜直肠癌根治术的术后优势分析

直肠癌一经确诊最有效的治疗方式就是手术切除.传统的开腹直肠癌根治术经过长时间的改良已日趋成熟,全结直肠系膜切除(Total Mesorectal Excision,TME)已成为手术治疗直肠癌的金标准.     

老年患者行腹腔镜直肠癌根治术的疗效

随着生活水平的提高,老年直肠癌患者逐渐增多,老年直肠癌患者并存疾病多,手术耐受力较低.腹腔镜下直肠癌根治术具有创伤小、并发症少、出血少、肠功能恢复快等优点,是治疗老年直肠肿瘤较为理想的选择[1].我院于2007年8月开始对老年直肠癌患者行腹腔镜直肠癌根治术至今,取得了满意的效果.     

腹腔镜、传统开腹直肠癌根治术疗效对比观察

目的 比较腹腔镜与传统开腹手术治疗直肠癌的临床疗效.方法 134例直肠癌(肿块直径＜6 cm;排除远处转移)患者,按意愿分为腹腔镜组(64例)和开腹组(70例),分别行腹腔镜根治术及传统开腹根治术.对两组手术效果进行比较.结果 腹腔镜组、开腹组清扫淋巴结数目及直肠远切端距肿瘤下缘的距离无统计学差异.腹腔镜组、手术时间明显短于开腹组,术中出血量明显少于开腹组,术后肠道功能恢复明显早于开腹组,并发症发生率明显低于开腹组,术后住院时间明显短于开腹组;但住院费用明显高于开腹组.两组上述指标比较,P均＜0.05.结论 腹腔镜直肠癌根治术安全、有效,与传统开腹手术比较,具有术中出血少、患者创伤小、术后恢复快及并发症发生率低等优势.     

腹腔镜低位直肠癌根治术的研究进展

随着腹腔镜设备和技术的迅速发展,手术经验的不断积累,应用腹腔镜治疗低位直肠癌根治效果好、安全性高,具有手术视野清晰、创伤小、生理干扰轻及术后正常活动恢复快的优势。为了探讨腹腔镜低位直肠癌手术的疗效,不断提高患者满意的肛门功能和生活质量,该文对近年来腹腔镜低位直肠癌根治术的研究概况进行综述。     

腹腔镜辅助下直肠癌根治术15例报告

目的 探讨腹腔镜下直肠癌根治手术的临床应用方法和操作要点. 方法对2006年9月～2007年3月的15例腹腔镜下直肠癌根治手术过程总结临床治疗效果. 结果 15例均在腹腔镜下完成手术,术中出血20～80 mL,无手术副损伤和并发症,术后胃肠功能恢复时间1～4 d(平均2 d). 结论 腹腔镜下直肠癌根治是很有特点的手术,操作安全、创伤小.沿正确解剖间隙分离是保证手术顺畅,减少出血或副损伤的关键,可达到根治性切除的效果.     

腹腔镜结直肠癌根治术的现状与展望

近年来腹腔镜结直肠癌根治术的应用不断得到拓展.本文从腹腔镜结直肠癌切除的手术方法、技术优势、疗效及卫生经济学评价、对免疫功能的影响、无瘤技术等方面综述了腹腔镜结直肠癌根治术的研究现状.     

Local recurrence after curative resection in patients with colon and rectal cancers

Background and aims  There are a range of rates and a number of prognostic factors associated with the local recurrence of colorectal cancer after curative resection. The aim of this study was to identify the potential prognostic factors of local recurrence in patients with colon and rectal cancers. Materials and methods  A retrospective review of 1,838 patients who underwent curative resection of non-metastatic colorectal cancer was conducted. The patients were treated between 1994 and 2004, and had a minimum follow-up of 3 years. Results  There were 994 patients with colon cancer and 844 patients with rectal cancer. The median duration of follow-up was 60.9 ± 24.5 months. With respect to colon cancer, the local recurrence rate was 6.1% (61 patients). With respect to rectal cancer, 95 patients had a local recurrence (11.3%), the rate of which was statistically greater than the local recurrence rate for colon cancer (p < 0.001). The overall recurrence rate was 16.4% (301 patients), and the local recurrence rate, with or without systemic metastases, was 8.5% (156 patients). Local recurrences occurred within 2 and 3 years in 59.9% and 82.4% of the patients, respectively. In patients with colon and rectal cancer, the pathologic T stage (p = 0.044 and p = 0.034, respectively), pathologic N stage (p = 0.001 and p < 0.001, respectively), and lymphovascular invasion (p = 0.013 and p = 0.004, respectively) were adverse risk factors for local recurrence. The level of the anastomosis from the anal verge was an additional prognostic factor (p = 0.007) in patients with rectal cancer. Conclusion  Compulsive follow-up care of patients with colon and rectal cancers is needed for 3 years after curative resection, especially in patients who have adverse risk factors for local recurrence.     

保留左结肠动脉在腹腔镜直肠癌前切除术中的临床应用和疗效观察

目的探讨腹腔镜直肠癌前切除术中保留左结肠动脉(LCA)与否对临床疗效的影响。方法回顾分析2015年7月至2018年7月山西省肿瘤医院结直肠肛门外科收治的行腹腔镜直肠癌前切除术病例的临床资料,共186例,其中保留LCA组80例(观察组),不保留LCA组106例(对照组)。比较两组患者手术相关指标,包括手术时间、术中出血量...     

手辅助腹腔镜与传统开腹直肠癌根治术的对比研究

目的通过手辅助腹腔镜与开腹下直肠癌根治术的对比研究,评估手辅助腹腔镜在直肠癌根治手术中应用的优劣。 方法对本院103例接受手辅助腹腔镜和开腹手术的直肠癌患者的基本临床资料、手术切口、术中出血、手术时间、术后恢复、病理结果、近期疗效等进行统计学分析。 结果两组患者的基本临床资料无统计学差异,手辅助腹腔镜组的手术切口长度、手术出血量、术后住院天数、术后镇痛、术后排气时间等方面明显优于开腹组,两组在手术时间、术后并发症发生率等方面无统计学差异。术后两组患者平均随访26个月,各自出现2例远处转移及复发,无切口种植情况。 结论手辅助腹腔镜直肠癌根治术是安全的微创手术方式,具有住院时间短、进食及肠道功能恢复快,疼痛减轻,出血量较少,手术彻底性良好的特点。     

手助腹腔镜与传统开腹直肠癌根治术的对比研究

目的通过手助腹腔镜与开腹下直肠癌根治术的对比研究,评估手助腹腔镜在直肠癌根治手术中应用的优劣。 方法对本院103例接受手助腹腔镜和开腹手术的直肠癌患者的基本临床资料、手术切口、术中出血、手术时间、术后恢复、病理结果、近期疗效等进行分析。 结果两组患者的基本临床资料无统计学差异,手助腹腔镜组的手术切口长度、手术出血量、术后住院天数、术后镇痛、术后排气时间等方面明显优于开腹组,两组在手术时间、术后并发症发生率等方面无统计学差异。术后两组患者平均随访26个月,各自出现2例远处转移及复发,无切口种植情况。 结论手助腹腔镜直肠癌根治术是安全的微创手术方式,都具有住院时间短、进食及肠道恢复快,疼痛减轻,出血量较少,手术彻底性良好的特点。     

Surgical outcome after curative resection of rectal leiomyosarcoma

PURPOSE: The aim of this study is to present the prognosis and possible associated prognostic factors after curative resection of rectal leiomyosarcoma. METHODS: From 1979 to 1996 our hospital saw 40 patients with rectal leiomyosarcoma, including 19 females, who did not have metastasis initially and received curative resection and regular postoperative follow-up. RESULTS: The mean age of the 40 patients was 58.7 years. Anal bleeding and perianal pain were the two most common symptoms at initial diagnosis. Twenty-nine patients received a radical surgical resection, such as abdominoperineal resection or low anterior resection; the other 11 patients received a wide local excision, such as transrectal excision or Kraske's operation. Sixteen tumors were classified as high-grade leiomyosarcoma, and 23 as low grade. Nineteen patients (48 percent) developed recurrence or metastasis postoperatively (median follow-up, 35 months). The overall and disease-free (1-year, 3-year, and 5-year) survival rates were 97, 90, and 75 percent and 90, 59, and 46 percent, respectively. In univariate analysis, younger group (<50 years, n=9,P=0.033) and high-grade leiomyosarcoma (P=0.043) showed poorer prognosis in the disease-free survival curve. In the multivariate Cox model, gender, tumor size, tumor location, and operation type did not significantly affect disease-free survival, whereas histologic grade (P=0.037) and age divided by a level of 50 years (P=0.009) were shown to be independent factors. There was a strong trend toward higher local recurrence rate for the wide local excision group than for the radical resection group (55vs. 24 percent,P=0.067) despite the wide local excision group being composed of smaller tumors (5.1vs. 7.5 cm,P=0.069). There was no difference in the incidence of distant metastasis between the two groups with different operation types. The metastasis rates of the wide local excision and radical resection groups were 27 and 38 percent, respectively. CONCLUSION: A younger age (<50 years) and a high histologic grade of tumor were the two most significant poor prognostic factors for rectal leiomyosarcoma. Radical resection may be superior to wide local excision in the prevention of local recurrence but not distant metastasis.     

Outcome analysis of elderly patients undergoing laparoscopic resection rectopexy for rectal prolapse

Purpose

For treatment of rectal prolapse, abdominal approaches are generally offered to younger patients, whereas perineal, less invasive procedures are considered more beneficial in the elderly. The aim of this study was to analyze whether laparoscopic resection rectopexy (LRR) is suitable for older patients.

Patients/Methods

Patients who received LRR for rectal prolapse were selected from a prospective laparoscopic colorectal surgery database. Perioperative and long-term outcome were compared between patients <75?years old (group A) and ≥75 years old (group B).

Results

Of 154 patients, 111 were in group A and 43 in group B. There was one conversion that occurred in group B. Overall mortality rate was 1.3% (n?=?2). Both patients were in group B (group B, 4.7%; p?=?0.079). Differences in major and minor complications between the groups were not significant. Rates of improvement for incontinence were 62.7% (group A) and 66.7% (group B; p?=?0.716); for constipation, the rates were 78.9% (group A) and 73.3% (group B; p?=?0.832). All recurrences occurred in group A (n?=?10; overall, 10.3%; group A, 13%). After exclusion of patients who had previously received perineal prolapse surgery, recurrence rate was 3.3% overall (group A, 4.3%).

Conclusions

This study supports the benefits of LRR for rectal prolapse in elderly patients. Age per se is not a contraindication for LRR. Elderly patients encounter complications slightly more frequently (although not statistically significant) than younger patients. Therefore, a very careful patient selection in the elderly is of paramount importance. However, the long-term outcome does not seem to differ between younger and elderly patients.     

Local tumor recurrence after curative resection for rectal cancer

Local tumor recurrence rates after curative rectal cancer surgery with the end-to-end anastomosis stapler (EEA^®) are reportedly high. Therefore, a retrospective review in ten Yale-affiliated hospitals was undertaken to establish the outcome of surgical resection for rectal cancer in this patient population. Of those 373 patients who had had curative resections, 192 (52 percent) were abdominoperineal resections (APR); 105 patients (28 percent) had restorative resections with sutured anastomoses, and the EEA stapler was used in 76 patients (20 percent). There was an equal distribution of tumors in the various Dukes' stages in all three procedures. Local tumor recurrence was: APR 19 percent, SUT 17 percent, and EEA 24 percent, but local tumor recurrence was more frequent after EEA than APR for tumors 7 to 10 cm from the anal verge (32 vs. 13 percent, respectively,P<0.05), and the time to recurrence was least in EEA patients. It is concluded that local tumor recurrence is higher than expected for all three procedures and that the EEA stapler was associated with a greater risk of local tumor recurrence. These findings are attributed to surgeon-related technical operative factors rather than to the nature of the tumors themselves.