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伴有严重合并症结直肠癌患者近期疗效比较

目的 比较腹腔镜与开腹手术治疗伴有严重合并症结直肠癌患者的近期临床效果.方法 回顾性分析福建医科大学附属第二医院2013年7月至2018年6月收治的228例术前伴有严重合并症的结直肠癌手术患者,依据手术方式分为腹腔镜组(173例)和开腹组(55例),比较分析2组患者围手术期情况.结果 腹腔镜组术中出血量为(88.1±1...     

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.     

腹腔镜下结肠癌根治术与开腹结肠癌根治术近远期疗效的对比分析

目的：总结喉部脂肪肉瘤的临床特征,提高对喉部脂肪肉瘤的认识。方法：回顾性分析一例我院收治的喉部脂肪肉瘤患者的临床特征、诊断、鉴别诊断和治疗,并查阅相关文献资料。结果：经支撑喉镜下取活检连同等离子切除后,本例患者睡眠打鼾、咽部不适、咳嗽等症状明显改善,经病理确诊为喉部脂肪肉瘤后患者到上级医院就诊。虽然上级医院建议行全喉切除术,但至今患者仍拒绝接受进一步治疗。目前患者无咳嗽,打鼾较术前明显减轻,仍有咽部异物感。结论：喉部脂肪肉瘤临床罕见,肿物生长缓慢,边界清楚,表面光滑,极易被误诊为喉部的良性肿瘤,诊断主要依靠病理检查结果,治疗主要为手术完整切除,切除范围应至少距肿物0.5cm。     

结直肠癌开腹与腹腔镜下手术疗效的前瞻性研究

目的:探讨腹腔镜手术治疗结直肠癌的可行性及近期疗效.方法:2006年4月至2008年6月本院腹部外科收治的结直肠癌患者,以TNM分期为依据,随机分为腹腔镜组59例及常规开腹组70例,对比评估两组的肿瘤切除范围、淋巴结清扫数、术中出血量、手术时间、围手术期输血、术后肠道功能恢复时间、手术对患者机体血常规和生化指标的影响、住院天数、手术费用、术后并发症、复发及转移等.结果:腹腔镜组达到与开腹组同样的肿瘤切除范围和淋巴结清扫(15.28枚vs 14.00枚,P>0.05).腹腔镜组术中出血量少于开腹组(260.68mL vs 304.43mL,P>0.05)、术后肠道功能恢复时间明显早于开腹组(3.20d vs4.30dP<0.05),术后住院天数短于开腹组(9.61d vs 13.06d,P<0.05).手术时间腹腔镜组前期较开腹组长(196.97min vs 156.86min P<0.05),但后期两组无差异(143.85min Vs155.00min P>0.05).手术费用腹腔镜组高于开腹组(51 897.93元vs 48 010.62元人民币,P<0.05).腹腔镜手术对患者血浆白蛋白ALB(35.561g/L vs 33.663g/L,P<0.05)、PALB(15.44g/L vs 13.61g/L,P<0.05)、Tp(65.685g/L Vs 63.863g/L,P<0.05)的影响均较开腹手术者轻.两组随访期间各有并发症5例,并发症率7%～8%,术后转移1例.两组切口均无肿瘤种植、无局部复发及近期死亡病例.结论:腹腔镜结直肠癌手术符合肿瘤根治原则,可达到与开腹手术同样的根治性治疗效果,近期疗效令人满意,并具有切口小、创伤轻、术后恢复快、并发症少、住院时间短、术后生存质量高等优点.腹腔镜结直肠癌手术将有广泛推广应用的价值.     

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与开腹手术对患者生活质量影响的比较

目的探讨采用腹腔镜行直肠癌根治术与开腹手术对患者生活质量的影响。方法选取2007年2月至2015年2月间收治的260例直肠癌根治术患者,根据随机数字表法分为观察组(132例)和对照组(128例)。观察组患者接受腹腔镜直肠癌根治术,对照组患者接受开腹手术,观察和比较两组患者的临床疗效、术后并发症及生活质量。结果与对照组相比,观察组患者淋巴结清扫数目、手术时间无明显变化(P>0.05),而术后排气时间、住院时间明显缩短(P<0.05);观察组患者切口感染、肠梗阻、吻合口出血、吻合口瘘、肺部感染等术后并发症发生率显著降低(P<0.05);观察组患者术后生活质量各维度及总分均明显增高(P<0.05)。结论腹腔镜直肠癌根治术具有损伤小、恢复快、并发症少等优点,较开腹手术可明显提高患者术后生活质量。     

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。     

腹腔镜手术对比开腹手术在结直肠癌根治术中的安全性及远期疗效评估

目的 探讨开腹手术与腹腔镜手术在结肠癌根治术中的安全性及远期疗效.方法 选取结直肠癌患者92例,将采用腹腔镜治疗的42例患者纳入研究组,将采用开腹手术治疗的50例患者纳入对照组.观察2组患者的手术时间,术中出血量,淋巴结清扫数目,腹腔引流量,肛门恢复排气时间,住院时间等疗效指标;观察2组患者术中术后并发症的发生情况;随访3年,对比2组患者的生存情况.结果 观察组患者术中出血量,肛门恢复排气时间和住院时间均显著小于对照组,差异有统计学意义,P＜0.05;观察组患者手术时间,淋巴结清扫数目,腹腔引流量与对照组相比差异无统计学意义,P ＞0.05.2组患者并发症发生率差异无统计学意义,P＞0.05.观察组患者术后1年、2年、3年生存率分别为100.00％,95.23％,88.09％;对照组患者术后1年、2年、3年生存率分别为96.00％,86.00％,74.00％.2组3年生存率差异有统计学意义,P＜0.05.结论 腹腔镜手术治疗结直肠癌可达到传统开腹手术相当的治疗效果,其远期生存率高于传统开腹手术.     

肾肿瘤腹腔镜根治切除术与开放手术的临床疗效比较

目的比较肾肿瘤腹腔镜根治切除术与开放手术的临床疗效。方法选择2012年4月至2014年7月间诊治的70例肾肿瘤患者,采用随机数字表法将患者随机分成观察组和对照组,每组35例。观察组患者接受腹腔镜肾肿瘤根治切除术,对照组患者接受开放手术,比较两组患者的治疗效果。结果观察组患者的住院时间、手术时间、肠道功能恢复时间、术中出血量、止痛药物用量明显低于对照组,并发症发生率也低于对照组,差异均有统计学意义(均P<0.05)。结论肾肿瘤腹腔镜根治切除术具有良好的疗效,术后并发症率低,值得临床推广与应用。     

腹腔镜结直肠癌根治术与同期开腹手术的回顾性研究

目的回顾性分析比较腹腔镜结直肠癌根治术与同期开腹手术患者的临床资料,探讨应用腹腔镜技术行结直肠癌根治术的可行性。方法 2004年8月至2009年4月腹腔镜辅助下结直肠手术184例,右半结肠癌根治术37例,横结肠癌根治术11例,左半结肠癌根治术31例,直肠癌Dixon手术53例、Miles手术49例、Hartmann手术3例;开腹结直肠癌根治术患者718例（开腹组）,其中右半结肠癌根治术107例,横结肠癌根治术54例,左半结肠癌根治术131例,直肠癌Dixon手术288例、Miles手术117例、Hartmann手术21例,对照比较两组患者的手术及术后情况。结果两组均无术中、术后严重并发症和手术死亡病例,腹腔镜组有4例中转开腹手术。腹腔镜组与开腹组的平均手术时间分别为（210.5±26.5）min和（95.5±12.5）min,差异有显著性（P〈0.05）。腹腔镜组术中失血量明显少于开腹组〔（85.5±12.5）ml比（200.5±22.5）ml,P〈0.05〕。清除的淋巴结数量,直肠前切除肿瘤远端切缘长度两组间差异无显著性。腹腔镜组术后胃肠功能恢复时间明显早于开腹组〔进食时间：（4.5±0.5）d比（5.5±0.5）d,P〈0.05）。腹腔镜组住院时间明显短于开腹组〔（9.5±0.5）d比（12.5±0.5）d,P〈0.05〕。两组的3,5年生存率比较差异无显著性（89.8%比89.7%,P〉0.05;75.5%比74.5%,P〉0.05）。结论腹腔镜结直肠癌切除术安全、有效,具有可行性。     

伴呼吸功能障碍的结直肠癌患者腹腔镜治疗的可行性分析

 目的　探讨伴呼吸功能障碍的结直肠癌患者接受腹腔镜治疗的可行性。方法　总结2007年8月至2009年11月收治的伴呼吸功能障碍的结直肠癌患者64例。遵循肿瘤根治原则,36例接受腹腔镜手术,28例行常规开腹手术。结果　腹腔镜组术后吸氧时间平均3.5 d,开腹组平均4.6 d（P＜0.05）;自主咳痰能力优于开腹组（P＜0.05）;腹腔镜组术后气管插管拔除时间平均21.2 min、开腹组平均23.9 min,差异无统计学意义（P＞0.05）;两组患者术后血氧饱和度波动范围腹腔镜组略优于开腹组,但差异无统计学意义（P＞0.05）;开腹组肺部感染1例,两组患者均无肺不张、呼吸衰竭及泌尿系感染病例。结论　伴呼吸功能障碍的结直肠癌患者适合应用腹腔镜手术治疗。     

Laparoscopic versus open colorectal resection for cancer: A meta-analysis of results of randomized controlled trials on recurrence

Aims

Laparoscopic resection for colorectal cancer remains controversial. This is because it is uncertain whether recurrence rates after laparoscopic-assisted surgery is comparable to those reported after open surgery. We performed a meta-analysis of the published literature in an attempt to answer this question.

Methods

Eligible articles were identified by searches of MEDLINE, EMBase and the Cochrane database. Prospective randomized clinical trials were eligible if they included patients with colorectal cancer treated by laparoscopic surgery versus open surgery and followed for recurrence.

Results

Ten trials with information on disease recurrence on 2474 patients were included. In the combined results, no statistically significant difference in the OR for overall recurrence between the laparoscopic surgery and open surgery group was found (OR 0.93, 95% CI 0.71–1.21, P = 0.58). Stratified by recurrence type, the combined results of the individual reports show no statistically significant difference for local recurrence (OR 0.80, 95% CI 0.50–1.29, P = 0.36), distant metastases (OR 0.90, 95% CI 0.62–1.29, P = 0.56) and port or wound-site recurrence (OR 1.04, 95% CI 0.18–6.03, P = 0.97) between the two surgical techniques.

Conclusion

This meta-analysis supports that the recurrence rates for patients with colorectal cancer treated by laparoscopic surgery do not differ from those for open surgery. Longer follow-up studies will further define outcomes, comparing the two techniques in the treatment of colorectal cancer.     

腹腔镜下结直肠癌根治术的现状和研究进展

腹腔镜下结直肠癌根治术经过近20年的临床应用，取得了比较肯定的临床疗效，而近年来的研究取得了一定的结果，本文拟对目前腹腔镜下结直肠癌的现状和研究进展作一综述。     

Circulating tumour cells during laparoscopic and open surgery for primary colonic cancer in portal and peripheral blood

Background

The objective of this study was to detect and quantify circulating tumour cells (CTC) in peripheral and portal blood of patients who had open or laparoscopic surgery for primary colonic cancer.

Methods

Patients in the laparoscopic-group were operated on in a medial to lateral approach (“vessels first”), in the open-group a lateral to medial approach was applied. The enumeration of CTC was performed with the CellSearch System. Intra-operative samples were taken paired-wise (from peripheral and portal circulation) directly after entering the abdominal cavity (T1), after mobilisation of the tumour baring segment (T2), and after tumour resection (T3). Ploidy of both the CTC and tissue of the primary tumour was determined for chromosome 1, 7, 8 and 17.

Results

Thirty-one patients were included; 18 patients had open surgery, 13 patients were operated on laparoscopically. The percentage of samples with CTC at T1 was 7% in peripheral blood and 54% in portal blood (p = 0.002). At T2, 4% and 31% respectively (p = 0.031). And at T3, 4% and 26% respectively (p = 0.125). The cumulative percentage of samples with CTC was significantly higher during open surgery as compared to the laparoscopic approach. Both the CTC and tissue of the primary tumour were diploid for chromosome 1, 7, 8 and 17.

Conclusion

The detection rate and quantity of CTC is significantly increased intra-operatively and is significantly higher in portal blood compared to peripheral blood. Significantly less CTC were detected during laparoscopic surgery probably as result of the medial to lateral approach.     

腹腔镜下结直肠癌根治术的现状和研究进展

腹腔镜下结直肠癌根治术经过近20年的临床应用,取得了比较肯定的临床疗效,而近年来的研究取得了一定的结果,本文拟对目前腹腔镜下结直肠癌的现状和研究进展作一综述.     

手助腹腔镜行结直肠癌切除术14例报告

目的：探讨采用手助腹腔镜（HALS）行大肠癌切除术的疗效。方法：对14例结、直肠癌患者,采用HALS行结、直肠癌切除术。结果：8例右半结肠癌中,6例采用HALS完成手术切除,手术时间为110－220min(平均160min),术中失血40－100ml,术后36－72h恢复肠鸣音,7－12d出院（平均8d）,并均按综合治疗计划行术后化疗;另2例中转开腹。6例下段直肠癌行腹会阴联合根治切除术中,5例采用HALS完成手术,手术时间为120－270min(平均180min),术中腹腔内失血40－80ml,术生24－72h恢复肠鸣音,12－18d出院（平均14d),患者均在术后7－8d拔除导尿管自行排尿,并按计划放、化疗;另1例因广泛盆腔粘连中转开腹。本组11例采用HALS行大肠癌根治术不仅达到了开腹根治术的要求,而且具备操作安全、简捷、微创、恢复快的优点,有利于患者免疫机能的恢复和术后生活质量的提高。但HALS行大肠癌根治术的远期疗效有待进一步观察。     

Peritoneal carcinomatosis is less frequently diagnosed during laparoscopic surgery compared to open surgery in patients with colorectal cancer

Background

During resection of a colorectal tumor a careful inspection of the abdomen should be performed to detect metastases. The aim of the current study was to compare the proportions of patients diagnosed with peritoneal carcinomatosis (PC) during laparoscopic resection (LR) and open resection (OR).

Methods

All patients who underwent resection for colorectal cancer in the Eindhoven Cancer Registry area between 2008 and 2012 were included. Proportions of patients with PC were compared between surgical techniques. Multivariate logistic regression analysis was performed.

Results

6687 Patients underwent resection for colorectal cancer, of whom 1631 patients (24%) underwent LR, 4665 patients (70%) underwent OR. Conversion took place in 391 patients (19% of laparoscopic treated patients). PC was diagnosed in 1.4% of patients undergoing LR, in 5.0% of patients undergoing OR, and in 3.3% of patients in whom LR was converted to OR (p < 0.001). After adjustment for patient and tumor characteristics (e.g., T- and N-stage), patients who were treated by LR had a lower chance to be diagnosed with PC during surgery than patients undergoing OR (odds ratio = 0.42, p < 0.001).

Conclusions

Patients undergoing surgery for colorectal cancer are less frequently diagnosed with PC during LR in comparison to OR. Since effective treatment is currently available for selected patients with PC, a thorough inspection of the peritoneum during surgery is of paramount importance to offer these patients a chance for long-term survival and even cure.