腹腔镜结直肠癌根治术与开腹手术远期疗效对比

目的：对比结直肠癌分别行腹腔镜结直肠癌根治术与开腹手术所取得的远期疗效。方法选择金湖县人民医院及江苏省人民医院收治的结直肠癌116例,随机分为观察组与对照组,每组58例。对照组以开腹结直肠癌根治术治疗,观察组以腹腔镜结直肠癌根治术治疗,对比两组患者的临床资料及其远期效果。结果观察组患者的手术时间及住院时间均短于对照组（均 P ＜0．05）,术中出血量明显少于对照组（P ＜0．05）;观察组术后并发症发生率为6．9％,对照组为29．3％,两组间差异明显（P ＜0．05）。观察组术后1、3与5年生存率分别为94．8％、86．2％、77．6％,对照组为72．4％、65．5％、55．1％,两组间差异显著（均 P ＜0．05）。结论腹腔镜结直肠癌根治术与开腹手术相比较,手术时间较短,术中出血量较少,可缩短住院时间,在治疗过程中所出现的术后并发症较少,且术后的生存率较高,在临床上可优先选择腹腔镜结直肠癌根治术。     

腹腔镜与开腹手术治疗直肠癌近期疗效对比研究

目的：比较腹腔镜直肠癌根治切除术和开腹手术的疗效。方法选取直肠癌患者85例,按治疗方法不同分为两组,观察组43例,给予腹腔镜直肠癌根治切除术;对照组42例,给予开腹手术治疗。比较两组患者的手术时间、术中出血量、住院时间,术后并发症的发生率,并定期随访患者,比较术后生存质量。结果两组患者均顺利完成手术,观察组及对照组手术时间分别为（128.19±7.05）min和（174.40±17.14）min,观察组及对照组术中出血量分别为（140.97±54.40）ml和（265.55±57.95）ml,观察组及对照组住院时间分别为（7.95±1.36）d和（12.60±3.62）d。观察组患者的手术时间、术中出血量及住院时间均低于对照组（P﹤0.05）;术后观察组患者的并发症发生率（11.6%）低于对照组（33.3%）（P﹤0.05）;术后随访患者3、6、12个月,观察组患者的生存质量分别为（79.45±9.18）分,（88.12±6.46）分,（91.67±7.12）分,对照组的生存质量分别为（77.13±5.79）分,（77.31±8.14）分,（80.54±6.93）分。随访3个月两组患者的生存质量比较差异无统计学意义（P﹥0.05）,但随访6个月、12个月后观察组患者的生存质量明显高于对照组（P﹤0.01）。结论相对于开腹手术,腹腔镜直肠癌根治切除术术中出血少,术后恢复快,并发症少,住院时间短,且术后患者的生存质量高,但临床工作中要合理掌握手术适应证。     

腹腔镜与传统开腹手术对低位直肠癌根治术的临床效果对比分析

目的 探讨腹腔镜与开腹手术在低位直肠癌根治术中的临床应用效果.方法 收集低位直肠癌患者68例,其中腹腔镜组患者38例,传统开腹组患者30例,对比分析两组患者的临床效果.结果 腹腔镜组患者的手术时间较开腹组长,但术中出血量、手术切口长度、术后排气时间以及住院时间要明显优于开腹组,差异具有统计学意义(P＜0.05),两组患者在淋巴结清扫以及手术切缘距癌肿下缘方面差异不具统计学意义(P＞0.05).腹腔镜组(18.4％)与开腹组(16.7％)围手术期并发症发生率比较,差异不具统计学意义(P＞0.05).半年,1年以及2年生存率、复发率以及低位保肛率和总保肛率,两组比较差异不具统计学意义(P＞0.05).结论 腹腔镜低位直肠癌根治术对患者的创伤小,利于患者术后恢复,值得临床上推广使用.     

腹腔镜辅助直肠癌根治术与传统开腹手术的临床疗效比较

目的探讨腹腔镜辅助直肠癌根治术对直肠癌的临床疗效。方法 2006年1月至2008年9月期间收治的直肠癌患者120例,根据手术方式不同分为腹腔镜和开腹组,每组60例。腹腔镜组患者采用腹腔镜辅助直肠癌根治术治疗,开腹组患者行传统开腹手术治疗,比较两组患者手术时间、术中出血量、排气时间、导尿管留置时间、术后住院时间以及手术前后血清CRP、IL-6水平,随访并比较两组患者1、3、5年生存率。结果腹腔镜组患者手术时间较开腹组长(P<0.05),术中出血量、术后排气时间、导尿管留置时间、术后住院时间均少于开腹组(P<0.05)。两组患者清扫淋巴结数目及并发症发生率差异无统计学意义(P>0.05)。开腹组患者术后血清CRP和IL-6水平均高于腹腔镜组(均P<0.05)。两组患者1、3、5年生存率差异无统计学意义,腹腔镜组>60岁患者的3、5年生存率高于开腹组(P<0.05)。结论腹腔镜辅助直肠癌根治术与传统开腹手术的近期和远期疗效相似,但具有手术创伤小、患者恢复快、能够保护机体免疫功能等优点,适宜在临床推广应用。     

腹腔镜直肠癌根治术的学习曲线研究

目的 评估腹腔镜直肠癌根治术不同阶段的手术效果,探讨无腹腔镜胆囊切除术经验的外科医师缩短学习曲线的要点.方法 分析2009年6月至2010年3月由同组无腹腔镜胆囊切除经验医师完成的45例腹腔镜直肠癌根治术患者的临床资料.按手术先后次序分A、B、c共3组,每组15例,记录手术频率,比较各组手术时间、术中出血量、中转开腹率、并发症、住院天数和淋巴结清扫数,分析不同阶段的手术效果.结果 3组病例在年龄、性别、病理分期、肿瘤部位、手术方式无显著差异,A组手术时间、出血量及术后住院时间高于B、C组,差异有统计学意义;B、C组间差异无统计学意义.A组中转开腹例数多于B、C组.各组检获淋巴结数无差异.结论 有丰富开腹直肠癌手术经验和内镜经验的同定团队,短期连续大量病例的学习,经过15例的学习曲线,可掌握腹腔镜直肠癌手术.     

腹腔镜直肠癌根治术和开腹手术直肠癌根治术的疗效及对患者胃肠功能影响的比较

目的 对比分析腹腔镜和传统开腹手术对直肠癌根治术患者的疗效及对胃肠功能的影响.方法 12例患者分为2组,腹腔镜直肠癌根治术组(LAP组)和开腹直肠癌根治术组(OP组),每组60例.对比分析2组患者手术指标,血清胃动素和胃泌素含量及并发症等情况.结果 LAP组与OP组相比,手术时间无差异性,但术中出血量、淋巴结清扫个数、术后进食时间、术后吗啡用量、术后镇痛时间及术后住院时间有差异性(P<0.05);腹胀排气时间、肛门排气时间、血清中胃动素和胃泌素有差异性(P<0.05);并发症发生率也有差异性(P<0.05).结论 腹腔镜直肠癌根治术可以减小手术创伤,加快恢复胃肠道功能,可能与提高胃动素和胃泌素的分泌有关.     

腹腔镜直肠癌根治术与传统开腹术的疗效比较

目的:回顾性研究腹腔镜根治术及传统开腹Dixon术在直肠癌中的治疗疗效.方法:选取2010年2月至2011年8月我院收治的124例直肠癌患者作为研究对象,根据治疗方法不同分为腹腔镜组(68例)和传统手术组(56例).腹腔镜组患者首先置入腹腔镜,然后在腹腔镜辅助下进行肠段的切除和吻合;传统手术组首先在下腹部做切口,然后对游离出的直肠进行肠段的切除和吻合,并在术后进行5年随访.回顾性分析两组患者的手术相关指标、术后并发症、远期疗效以及5年累积生存率等.结果:与传统手术组相比,腹腔镜组患者的手术时间[(171.33±38.41) min]明显延长,术中出血量[(162.87±31.44) ml]及术后腹腔引流量[(140.57±42.33) ml]明显降低,肛门排气时间[(2.37±0.42) d]和住院时间[(10.16±2.27) d]缩短;在随访中发现,与传统手术组患者相比,腹腔镜组患者的切口感染、吻合口瘘、吻合口出血以及肠梗阻等术后并发症的发生率显著降低,而且腹腔镜组患者的局部复发率以及性、排尿功能障碍发生率较传统手术组患者更低,差异均有统计学意义(P<0.05).5年累积生存率(77.9%)显著提高,差异均有统计学意义(P<0.05).结论:腹腔镜根治术相比传统开腹Dixon术,其手术创伤较小、术后恢复快,术后并发症发生率及肿瘤复发率少,生存率更高,具有更好的临床效果,值得进一步推广.     

腹腔镜直肠癌根治术8例

 目的 探讨腹腔镜直肠癌根治术实施的可能性、方法及并发症的预防。方法 共施行了腹腔镜直肠癌根治术8例，其中Dixon手术3例，结肠肛管拖出术（改良Bacon手术）1例。Miles手术4例。结果 手术均获成功，无中转开腹。手术平均时间220 min（195～250 min），术中平均出血量100 ml（10～500 ml），1例吻合口瘘，住院时间10 ~ 18 d。结论 腹腔镜直肠癌根治术有创伤小、出血少、胃肠干扰少、术后疼痛轻、恢复快等优点，可以达到安全根治性切除肿瘤的目的，近期效果满意。     

腹腔镜与开腹结直肠癌根治术的近远期疗效比较

目的探讨分析腹腔镜下结直肠癌根治的安全性和可行性,对比其与开腹手术的近远期疗效。方法回顾性分析我院2006年1月至2011年12月间结肠及中上段直肠癌根治术患者的临床资料,其中开腹手术120例,腹腔镜下手术76例。分析比较两组患者的临床病理资料、围手术期情况及近远期生存情况。结果两组患者年龄、性别比较无统计学差异。腹腔镜组平均手术时间大于开腹组,分别为(226.28±61.09)min和(193.50±53.79)min;术中失血量腹腔镜组小于开腹组,分别为(84.00±28.41)ml和(187.60±37.27)ml;术后住院时间腹腔镜组小于开腹组,分别为(7.55±2.04)d和(8.40±3.39)d。两组患者肠管近端及远端切缘长度、清扫淋巴结数目以及术后感染性和非感染性并发症发生率比较,差异无统计学意义。开腹组与腹腔镜组结直肠癌患者术后3、5年生存率分别为76.8%、65.7%和76.6%、71.2%(P>0.05);Duke’s A、B、C各期两组患者生存率比较无统计学差异。结论腹腔镜结直肠癌根治手术安全可行,具有出血少、术后恢复快等优点,肿瘤安全性、并发症发生率及术后近远期疗效不亚于开腹手术。     

Biological predictive factors in rectal cancer treated with preoperative radiotherapy or radiochemotherapy

We analysed the expression of microsatellite instability, p53, p21, vascular endothelial growth factor and thymidylate synthase (TS) in pretreatment biopsy specimens from 57 locally advanced rectal cancers. The aim of the study was to correlate the expression of these markers with pathological response. Nineteen patients were treated with preoperative concomitant radiotherapy (RT) and fluorouracil/oxaliplatin-based chemotherapy (RCT), while 38 had RT alone. Pathological complete remission (pCR) and microfoci residual tumour (micR) occurred more frequently in patients treated with RCT (P=0.002) and in N0 tumours (P=0.004). Among patients treated with RCT, high TS levels were associated with a higher response rate (pCR+micR; P=0.015). No such correlation was found in the RT group. The other molecular factors were of no predictive value. Multivariate analysis confirmed a significant interaction between nodal status and the probability of achieving a pathological response (P=0.023) and between TS expression and treatment, indicating that a high TS level is predictive of a higher pathological response in the RCT subset (P=0.007). This study shows that lymph node status is the most important predictive factor of tumour response to preoperative treatment. Thymidylate synthase expression assessed immunohistochemically from pretreatment tumour biopsies may be a useful predictive marker of rectal tumour response to preoperative RCT.     

Temporary impairment of renal function in patients with rectal cancer treated with diverting ileostomy

BackgroundFluid and electrolyte disturbance, which impairs renal function, has been reported in patients with temporary ileostomy. However, the dynamic changes in serum electrolytes and renal function in rectal cancer patients with ileostomy have not been well described. In the present study, we aimed to evaluate alterations in serum electrolytes and renal function in rectal cancer patients undergoing ileostomy creation and closure.MethodsThe levels of serum potassium, serum sodium, serum blood urea nitrogen, serum creatinine and estimated glomerular filtration rate (eGFR) were analyzed in 320 patients with rectal cancer including 156 patients with an ileostomy (the ileostomy group) and 164 patients without an ileostomy (the control group).ResultsAfter index surgery, the levels of serum potassium and serum creatinine in the ileostomy group were significantly higher than those in the control group (P<0.05). In contrast, the levels of serum sodium and the eGFR showed decreases in the ileostomy group compared to the control group after index surgery (P<0.05). At 3 months after ileostomy creation, the ileostomy group had a significantly increased rate of eGFR <60 mL/min/1.73 m² compared to the control group (5.8% vs. 1.2%, P=0.032). In line with the results of univariate analysis, multivariable analysis identified ileostomy and diabetes as independent risk factors for a decreased eGFR (P=0.005 and P=0.022, respectively). Furthermore, a significantly rebound of eGFR was observed in patients after ileostomy closure (P=0.013).ConclusionsIleostomy can cause temporary electrolyte disturbance and renal function impairment in patients with rectal cancer. Diabetes is an independent risk factor for renal function damage in patients with rectal cancer who receive a temporary ileostomy.     

全身麻醉复合硬膜外阻滞对行腹腔镜手术老年直肠癌患者的影响研究

目的 探讨全身麻醉复合硬膜外阻滞对接受腹腔镜手术治疗的老年直肠癌患者的影响.方法 将70例行腹腔镜手术的老年直肠癌患者随机分为对照组及观察组,每组35例.对照组给予气管插管全身麻醉,观察组在此基础上,复合硬膜外阻滞麻醉,分别在术前、麻醉复苏前、术后第1天,对比两组患者胰岛素抵抗指数(IR)、血糖(BS)、肾上腺素(AD...     

直肠癌Miles术后放化疗同步与单纯化疗效果分析

目的探讨Duke's C期直肠癌患者行腹会阴联合切除术(Miles术)后,予同步放化疗和单纯化疗的疗效差异。方法统计临床病例132例,男69例,女63例。年龄29～71岁。肿瘤距肛门缘均在5cm以下。术后病理检查均是中低分化腺癌,肠壁和(或)系膜淋巴结见转移灶(Duke's C)。其中随机抽取78例予以术后同步放化疗,其余54例采用术后单纯化疗。手术方法:采用腹会阴联合切除术(Miles术)。化疗方案:奥沙利铂130mg/m~2d1,亚叶酸钙100mg/m~2 d1～5,氟尿嘧啶350mg/m~2 d1～5(每月1次,连续6个月)。放射治疗方法:术后放射治疗定位采用CT模拟机,应用15MVX线,1.8Gy/次,5次/周,总剂量50.4Gy。术后4周内,放射治疗与第一个疗程的化疗同步进行。结果①局部复发率:术后随访5年,局部复发18例,其中化疗组12例,复发率22.22%,放化疗同步组复发6例,复发率8.33%。经x~2检验有统计学差异;②远处转移:术后随访5年,远处转移65例,其中化疗组28例,转移率51.85%,放化疗同步组转移37例,转移率47.44%。经x~2检验无统计学差异;③5年生存率:术后随访5年生存53例,其中化疗组16例,生存率29.63%,放化疗同步组生存37例,生存率47.44%。经x~2检验有统计学差异。结论①Duke's C期直肠癌患者行腹会阴联合切除术(Miles术)后,同步放化疗组较单纯化疗组局部复发率明显下降;②Duke's C期直肠癌患者行腹会阴联合切除术(Miles术)后,同步放化疗组较单纯化疗组远处转移率未见差异;③Duke's C期直肠癌患者行腹会阴联合切除术(Miles术)后,同步放化疗组较单纯化疗组5年生存率有明显提高。     

Differences in toxicity across gender in patients treated with chemoradiation for rectal cancer

The primary objective was to prospectively investigate the efficacy and toxicity of bolus 5‐fluorouracil (5‐FU) chemotherapy compared with the infusional 5‐FU in combination with preoperative radiation in patients with locally advanced rectal cancer. Furthermore, in light of previous reports, toxicity profiles between men and women were also compared. Eighty‐four consecutive patients with rectal adenocarcinoma were prospectively treated. There were no differences in tumour response, local recurrence or survival between bolus versus infusional groups or gender groups. In locally advanced rectal cancer, preoperative infusional chemotherapy combined with radiation was found to be less toxic than bolus chemotherapy and radiotherapy. Both regimens produced more toxic effects in women compared with men.     

左半结肠癌与直肠癌临床病理特征及生存期的比较

目的： 研究左半结肠癌和直肠癌患者的临床病理特征及生存期之间的差异。 方法： 选取2011年1月至2012年1月在 第二军医大学长海医院行手术切除的323例原发性结直肠癌患者为研究对象,收集患者临床特征资料,以手术日期或病理确诊日 期为随访起点对患者或家属进行随访,以死亡为终点事件,随访时间截至2017年8月1日。 结果： 左半结肠癌和直肠癌患者在首 发症状、组织学类型、肿瘤分期、术前是否贫血、p53阳性率及 BRAF 基因突变状态之间差异有统计学意义（ χ 2 =59.088,4.188, 24.305,11.956,4.221,4.001;均 P <0.05）。左半结肠癌和直肠癌中位生存时间均未观察到。左半结肠癌、直肠癌的5年生存率分别 为79.2%、74.3%。Ⅰ期、Ⅱ期左半结肠癌和直肠癌患者生存曲线差异无统计学意义（ P> 0.05）,Ⅲ期左半结肠癌和直肠癌患者生存曲 线差异无统计学意义（ P >0.05）。Cox比例风险分析结果显示,病理类型( HR =1.759, P <0.05)和肿瘤分期( HR =2.104, P <0.01)是影响 结直肠癌患者OS的独立危险因素。 结论 ：左半结肠癌和直肠癌生存时间未见不同,病理类型及肿瘤分期可能为结直肠癌患者 OS的影响因素。     

超高龄低位直肠癌保肛手术对控便功能的影响

目的探讨超高龄(≥75岁)低位直肠癌保肛手术对肛门控便功能的影响。方法选取39例年龄≥75岁,肿瘤距离肛缘≤7cm的低位直肠癌患者,分别采用不同的保肛手术治疗,对患者术后控便情况进行了对比研究。结果36例患者入组研究,患者排便次数达到正常的时间为(9.8±2.86)个月;贮袋组术后(7.67±1.66)个月排便次数趋于正常,与直吻组(10.56±2.83)个月比较差异有统计学意义,P=0.001;术后36.1%患者出现I度失禁的表现,贮袋组与直吻组比较差异无统计学意义,P=0.067;保肛术后贮袋组直肠测压指标优于直吻组。术后1年91.7%的患者对控便情况表示满意。结论超高龄老年患者虽然保肛术后对于控便能力有所下降,但是这种控便能力的下降是可接受的,且采用结肠贮袋直肠肛管吻合术能够明显改善超高龄患者近期的控便功能。     

Abdominosacral resection: Long-term outcome in 86 patients with locally advanced or locally recurrent rectal cancer

Aims

The purpose of this study is to evaluate the outcome of abdominosacral resections (ASR) in patients with locally advanced or recurrent rectal cancer.

Methods

From 1994 until 2012 patients with locally advanced rectal cancer (LARC) and locally recurrent rectal cancer (LRRC) underwent a curative ASR and were enrolled in a database. The postoperative complication rates, predictive factors on oncological outcome and survival rates were registered.

Results

Seventy-two patients with LRRC (mean age 63; 44 male, 28 female) and 14 patients with LARC (mean age 65; 6 male, 8 female) underwent ASR. R0 resection was achieved in 37 patients with LRRC and 11 patients with LARC. Twenty-seven patients underwent an R1 resection (3 in the LARC group). Eight patients had an R2 resection, compared to no patients in the LARC group. In respectively 26 and 1 patients of the LRRC and LARC groups a grade 3 or 4 complication occurred and the 30-days mortality rate was respectively 3% and 7%. The 5-years overall survival was 28% and 24% respectively.

Conclusion

En bloc radical resection remains the primary goal in the treatment of dorsally located (recurrent) rectal cancer. After thorough patient selection, ASR is a safe procedure to perform, shows acceptable morbidity rates and leads to a good oncological outcome.