腹腔镜和开腹结肠癌根治术远期疗效分析

目的：评价腹腔镜和开腹结肠癌根治术在远期疗效方面的差异。方法：回顾性分析2003年10月—2009年6月由同一手术组医师实施的183例结肠癌根治术患者的临床资料,根据手术方式的不同分为腹腔镜手术组（n=81）和开腹手术组（n=102）,对2组患者在不同分期下的术后远期并发症、局部复发、远处转移及5年存活率进行比较。结果：2组患者在性别、年龄、病理类型、肿瘤位置等方面差异无统计学意义（P〉0.05）。除术后粘连性肠梗阻发生率腹腔镜手术组少于开腹手术组外（Ⅰ/Ⅱ期,7.0%vs22.6%,P=0.036;Ⅲ期,7.9%vs24.5%,P=0.042）,2组患者在切口疝、种植率、局部复发及远处转移方面差异均无统计学意义（P〉0.05）。5年累积存活率比较,Ⅰ/Ⅱ期腹腔镜手术组为77.4%,开腹组为75.7%,差异无统计学意义（P=0.626）;Ⅲ期腹腔镜手术组为71.8%,开腹手术组为65.6%,差异也无统计学意义（P=0.517）。结论：腹腔镜结肠癌根治术远期疗效与开腹手术相似,但术后远期并发症少,值得推广。     

腹腔镜结直肠癌根治术与开腹手术近远期疗效的比较

目的 比较腹腔镜结直肠癌根治术与开腹手术的近远期临床疗效.方法 回顾性分析1998 年1月至2008 年12 月在本院行结直肠癌根治性手术的375例患者的临床病理资料,根据其手术方式分为腹腔镜手术组（72例）和开腹手术组（303例）,比较两组的一般资料、手术时间、出血量、淋巴结数目、肛门排气时间、术后住院时间、术后并发症及术后无瘤生存率.结果 腹腔镜组和开腹手术组资料具有可比性,在出血量（121.81 ml vs 160.41 ml）、肛门排气时间（3.03 d vs 3.90 d）、术后住院时间（12.03 d vs 15.69 d）腹腔镜组优于开腹手术组（P均 〈 0.05）,两组手术时间（209.79 min vs 198.50 min）、淋巴结数目（10.82 vs 9.48）及术后并发症发生率（23.61% vs 26.07%）差异无统计学意义,腹腔镜组术后3、5年无瘤生存率分别为67.7%、60.3%,开腹手术组分别为66.8%、53.5%,两组比较差异无统计学意义,按病理分期分层分析两组的术后无瘤生存率仍差异无统计学意义.结论 腹腔镜结直肠癌根治术近期疗效优于开腹手术,远期疗效与开腹手术相当,腹腔镜结直肠癌根治术具有可行性.     

腹腔镜与开腹直肠癌切除术短期疗效的比较

目的:探讨腹腔镜辅助直肠癌手术的可行性,对比腹腔镜辅助与传统开腹手术治疗直肠癌的短期疗效.方法:回顾分析2009年5月至2011年4月45例直肠癌患者的临床资料,根据患者意愿,分为腔镜组(21例)和传统开腹组(24例).对比分析两组患者Dukes分期,Dixon术切除标本肿瘤下缘距下切缘的长度,淋巴结清扫数量,手术时间...     

腹腔镜辅助与开腹结肠癌根治术的对比研究

目的:探讨腹腔镜辅助及开腹结肠癌根治术的临床疗效.方法:回顾分析31例腹腔镜辅助结肠癌根治术(腹腔镜组)及52例开腹结肠癌根治术(开腹组)的临床资料.两组患者年龄、性别、肿瘤位置及分期等无显著差异.结果:腹腔镜组手术时间比开腹组长(P =0.452),但出血少(P=0.039),术后肠道功能恢复快,住院时间短;肿瘤切除...     

Gastrointestinal recovery following laparoscopic vs open colon surgery

Background: We prospectively studied the recovery of gastrointestinal motility in patients undergoing laparoscopic (LAP, n=7) or open (OPEN, n=7) colon resections. Methods: At operation, bipolar recording electrodes were placed on the proximal and distal antrum, the proximal site of the colonic anastomosis, and the rectosigmoid for postoperative myoelectric recordings. Results: Shorter postoperative hospitalization and earlier resumption of a regular diet of the LAP group just barely failed to achieve significant differences when compared with the OPEN group (p=0.091, p=0.050, respectively). There were no differences between groups for slow wave frequency, amplitude, or dysrhythmias in the antrum, nor for return of discrete (DERA) and continuous (CERA) electrical response activity in the colon. Percentage of slow waves with spike activity tended to increase with passage of time postoperatively in both groups. There was a significant difference between POD 3 and 7+ in the LAP group (p<0.05). However, there were no significant differences in the percentage of slow waves with spike activities between groups on any postoperative day. Conclusions: The potential benefits of using a laparoscopic approach to colon resection are not clearly confirmed by these data. While such an approach may possibly result in shorter hospitalization, it appears to offer at best only modest increases in the rapidity of recovery of gastrointestinal function.Presented at the annual meeting of the Society of American Gastrointestinal Endoscopic Surgeons (SAGES), Orlando, Florida, USA, 11–14, March 1995     

Outcomes of self-expandable metal stent as bridge to surgery versus emergency surgery for left-sided obstructing colon cancer: A retrospective cohort study

BackgroundLong-term outcomes of self-expandable metal stents (SEMSs) as bridges to surgery versus emergency surgery in the treatment of left-sided obstructing colon cancer remain unclear.MethodsUsing a nationwide inpatient database in Japan, we performed one-to-one propensity score matching to compare overall survival, the stoma requirement, postoperative complications, and the length of stay between the SEMS and emergency surgery groups.ResultsCompared with the emergency surgery group, the SEMS group showed worse survival (hazard ratio, 1.80; 95% confidence interval, 1.07–3.01), a higher incidence of postoperative ileus (8% vs. 4%, P = 0.010), a longer postoperative length of stay (14 vs. 12 days, P < 0.001), and a lower stoma requirement (10% vs. 29%, P < 0.001).ConclusionsSEMSs as bridges to surgery are associated with significantly poorer overall survival, a higher incidence of postoperative ileus, a longer length of stay, and a lower stoma requirement than is emergency surgery.     

Laparoscopic versus open surgery for extraperitoneal rectal cancer: a prospective comparative study

Background The role of laparoscopic resection (LR) in the management of extraperitoneal rectal cancer still is unclear. This study aimed to compare perioperative and long-term results of laparoscopic and open resection (OR) for low and midrectal cancer. Methods A prospective nonrandomized trial comparing patients submitted to OR or LR for low and midrectal cancer at a single institution was conducted. Results The study included 191 consecutive patients: 98 patients who underwent LR and 93 who underwent OR. The mean follow-up period was 46.3 months for LR and 49.7 months for OR. The conversion rate for LR was 18.4%. With the use of LR, the mean time for complete patient mobilization was shorter (1.7 vs 3.3 days; p < 0.001) and patients were earlier in passing flatus (2.6 vs 3.9 days; p < 0.001) and stools (3.8 vs 4.7 days; p < 0.01), and in resuming oral intake (3.4 vs 4.8 days; p < 0.001). The mean hospital stay was shorter for LR, but the difference did not reach significance (11.4 vs 13 days). Morbidity and mortality rates were similar: LR (24.4% and 1%) and OR (23.6% and 2.2%). Laparoscopic patients presented a higher rate of anastomotic fistulas (13.5% vs 5.1%) and reoperations (6.1% vs 3.2%) but the difference was statistically nonsignificant. Laparoscopic resection presented a significantly lower local recurrence rate (3.2% vs 12.6%; p < 0.05). The cumulative survival and disease-free rates at 5 years were, respectively, 80% and 65.4% after LR and 68.9% and 58.9% after OR (nonsignificant difference). Stage-by-stage comparison showed prolonged cumulative survival for stages III and IV cancer in LR (82.5% vs 40.5%; p = 0.006 and 15.8% vs 0%; p = 0.013, respectively) and a reduced rate of cancer-related death for stage III in LR (11.4% vs 51.9%; p = 0.001). Conclusions As compared with conventional open surgery, LR for low and midrectal cancer is characterized by a faster recovery and similar overall morbidity (but a higher rate of anastomotic leakages), and does not present any adverse oncologic effect.     

腹腔镜乙状结肠癌根治术15例

目的探讨腹腔镜乙状结肠癌根治术的临床价值。方法回顾性分析2008年5月至2013年5月腹腔镜下乙状结肠癌根治术15例的临床资料。结果全组15例均在腹腔镜下完成手术,其中9例经体外行端端吻合,5例经肛门行直肠-乙状结肠端端吻合,1例行降结肠端造瘘。术后无吻合口瘘、吻合口出血等并发症发生,手术时间（192．8±33．5）min,平均186．8min,术中出血量（68．5±14．6）ml,平均59．6ml,术后住院时间（8．6±2．5）d,平均9．1d。结论腹腔镜乙状结肠癌根治术手术创伤小、术后恢复快,是治疗乙状结肠癌安全、可行的方法,但术者需有丰富的腹腔镜手术和结肠外科手术经验。     

Systematic review on the short-term outcome of laparoscopic resection for colon and rectosigmoid cancer

OBJECTIVE: Several large randomized controlled trials on laparoscopic resection for colon and rectosigmoid cancer have recently been published. There is a need to provide an up-to-date systematic review in this subject. METHODS: A literature search of all published randomized trials in English between January 1991 and September 2005 was obtained, from Ovid MEDLINE, EMBASE, CINAHL, and All EBM Reviews (Cochrane Central Register of Controlled Trial, Cochrane Database of Systemic Review, and Database of Abstracts of Reviews of Effects), including e-links to the related articles. Two independent assessors reviewed the trials using a standardized protocol. Where means and standard deviations were available, meta-analysis was performed using the Forest plot review. Studies where medians and ranges were presented were separately analysed. RESULTS: A total of 17 randomized controlled trials with 4013 procedures were reviewed. The conversion rate varied widely between studies and was lowest in single-Centre trials. There were no significant differences in overall and surgical complication rate, anastomotic leak rate, re-operation rate and oncological clearance. However, laparoscopic resection has a significantly lower peri-operative mortality (odds ratio 0.33; P = 0.005), lower wound complications (odds ratio 0.65; P = 0.01), less blood loss (weighted mean difference 0.11 l; P < 0.00001) and reduced postoperative pain scores by 12.6% with reduction of requirements for narcotic analgesia by 30.7%. After laparoscopic surgery, patients passed flatus 38.8% earlier (weighted mean difference 27.6 h; P < 0.00001) and had bowel movement 21.0% earlier (weighted mean difference 23.9 h; P < 0.00001) and resumed oral diet 28.3% sooner than patients in the open group (weighted mean difference 27.3 h; P < 0.00001). Patients were discharged 19.1% earlier after laparoscopic surgery than open surgery (weighted mean difference 1.7 days; P < 0.00001). Laparoscopic resection took 28.7% longer (weighted mean difference 40.1 min; P < 0.00001) to perform. CONCLUSIONS: Laparoscopic resection for colon and rectosigmoid cancer is feasible, safe and has many short-term benefits.     

Laparoscopic colon surgery for benign disease: a comparison to open surgery.

BACKGROUNDS AND OBJECTIVES: There remains a debate in the literature about the advisability of laparoscopic surgery for malignant disease of the colon. Current prospective studies will hopefully answer this question. However, for benign diseases of the colon, we believe laparoscopic surgery offers many advantages including decreased postoperative pain, early discharge from the hospital, and early return to normal activities. We retrospectively reviewed our experience with laparoscopic colectomies for benign disease to see whether these procedures could be done safely and if the proposed advantages could be realized. METHODS: Thirty-eight laparoscopic colon resections performed for benign disease were compared to 39 open colon resections with respect to operating times, length of hospital stay, estimated blood loss, days until first postoperative bowel movement, and complications. RESULTS: The laparoscopic colon resection group had decreased length of stay, less blood loss, earlier return of bowel function, and an equivalent number of complications. Laparoscopic cases did take an average of 24 minutes longer. CONCLUSION: The use of laparoscopic colon surgery for benign disease not only affords the patient the advantage of the laparoscopic approach, but also allows the surgeon to gain experience while awaiting the results of ongoing trials for laparoscopic colon surgery in malignant disease.     

腹腔镜右半结肠淋巴结清扫与开腹术的比较分析

目的 随机对比分析研究腹腔镜下右半结肠根治术与同期开腹手术的淋巴结清扫效果.方法 回顾性分析本院近 2 年（ 2011 年 6 月至 2013 年 6 月） 37 例腹腔镜下右半结肠根治患者相关资料,与同期 31 例开腹手术以手术时间、淋巴结清扫数目、术后并发症、住院时间等指标作对比研究.结果 两组术前资料无明显差异;腹腔镜组手术时间长于开腹组,住院时间较开腹组缩短,两组术后并发症发生率无统计学意义,腔镜组淋巴结清扫数目较开腹组明显增多（ P ＜ 0.05 ）.结论 腹腔镜技术在明显缩短患者住院时间的同时,在右半结肠根治的淋巴结清扫中亦凸显出一定程度的优势.     

单孔与多孔法腹腔镜手术治疗腹股沟疝的回顾性对比研究

目的探讨单孔腹腔镜腹股沟疝修补术的安全性和可行性。方法 2009年12月至2011年3月行单孔腹腔镜腹股沟疝修补术11例（单孔组）,其中直疝2例,斜疝9例。10例行单孔腹腔镜完全腹膜外疝修补术（TEP）,1例行经腹腔腹膜前修补术（TAPP）。同期多孔法腹腔镜手术患者18例（多孔组）,其中直疝5例,斜疝13例。16例行TEP,2例行TAPP。收集两组患者围手术期资料进行比较分析。结果两组在术中出血量（P=0.579）和术后住院时间（P=0.839）方面比较差异无统计学意义。在手术时间方面,单孔组长于多孔组（P=0.016）,差异有统计学意义。术后随访3～18个月,两组术中、术后并发症比较差异无统计学意义。结论单孔腹腔镜腹股沟疝修补术安全、有效,具有可行性。其临床应用价值仍需进一步的临床研究证实。     

腹腔镜与开腹结直肠癌手术短期效果的对比研究

目的:对比分析腹腔镜与开腹结直肠癌手术的短期效果。方法:回顾分析2001～2010年1 743例结直肠癌患者的临床资料,其中864例行腹腔镜手术8,79例行开腹手术。结果:相对开腹组,腹腔镜组切口小([5.5±1.8)cm vs.(23±3.5)cm,P<0.01;]失血量少([110±41)ml vs.(350±56)ml,P<0.01);]术后阿片类镇痛剂使用例数少(179 vs.261,P<0.01);首次下床活动时间早([1.9±0.9)天vs.(2.5±1.2)天,P<0.01;]肠道功能恢复快([2.5±0.6)天vs.(3.8±0.7)天,P<0.01;]术后住院时间短[(6.5±1.3)天vs.(8.4±1.5)天,P<0.01;]术后并发症发生率低(15.7%vs.27.6%,P<0.01)。淋巴结清扫数量、标本切缘阳性率两组差异无统计学意义(P>0.05)。结论:腹腔镜结直肠癌手术安全可行,可取得与开腹手术相同的根治效果,且具有切口小、出血少、疼痛轻、术后住院时间短、并发症发生率低等优势,值得推广。     

Short-term outcome analysis of a randomized study comparing laparoscopic vs open colectomy for colon cancer

The authors examined the impact of the laparoscopic approach on the early outcome of resected colon carcinomas. The role of laparoscopic techniques in the treatment of colon carcinomas is questionable. Previous studies have suggested technical feasibility of surgical resections of these cancers by laparoscopic means and have implied a benefit to laparoscopic technique for patients undergoing colorectal resections. A prospective, randomized study was conducted comparing laparoscopic assisted colectomy (LAC) open colectomy (OC) for colon cancer. We present the preliminary results in relation to the short-term outcome and judge the feasibility of the laparoscopic procedure to as a way of performing accurate oncologic resection and staging. Benefit has been demonstrated with LAC in this setting. Passing flatus, oral intake, and discharge from hospital occurred earlier in LAC- than OC-treated patients The mean operative time was significantly longer in the LAC group than in the OC group. The overall morbidity was significantly lower in the LAC group. No significant differences were observed between both groups in the number of lymph nodes removed or the pathological stage following the Astler-Coller modification of the Dukes classification. The laparoscopic approach improves the short-term outcome of segmental colectomies for colon cancer. However, the further follow-up of these patients will allow us to answer in the near future whether or not the LAC may influence the long-term outcome.Presented at the annual meeting of the Society of American Gastrointestinal Surgeons (SAGES), Orlando, FL, USA, 11–14 March 1995     

Laparoscopic vs transverse incision right colectomy for colon carcinoma

Aim We investigated whether laparoscopic right colectomy has short‐term and/or oncological advantages compared with transverse incision right colectomy. Method Patients who underwent an elective laparoscopic right colectomy or an open right colectomy through a transverse incision at the VU University Medical Center or Zaans Medical Center from 2005 to 2009 were prospectively followed. Results Patient groups were comparable in terms of gender, body mass index and American Society of Anesthesiology classification. Patients in the transverse incision group were older (68 years vs 75 years, P = 0.07) and blood loss was greater during this procedure (60 ml vs 130 ml, P = 0.001), which cost less than the laparoscopic procedure (€6.033 vs€7.221, P = 0.03). Hospital stay for the laparoscopic group was shorter (8 days vs 9 days, P = 0.04), but laparoscopic procedures took longer (155 min vs 77 min, P < 0.001) and 8% of patients in the laparoscopic group were converted to a median laparotomy. Postoperative complications were comparable for both groups (28%vs 32%, P = 0.74), and in both groups a radical resection rate of 96% (P = 0.94) was achieved. At a median follow up of 20 months the incidence of incisional hernia was similar in both groups and no patient required additional surgery as a result. Overall survival at 60 months was 70% for the laparoscopic group and 67% for the transverse incision group (P = 0.84). Conclusion There are few clinically relevant differences between a laparoscopic right colectomy and a transverse incision right colectomy. Transverse incision right colectomy is cheaper. The study may be the first to compare these two techniques, but it is a nonrandomized trial and therefore has its limitations.     

腹腔镜与开放胰十二指肠切除术疗效的对比观察

目的：探讨腹腔镜胰十二指肠切除术（LPD）的手术和肿瘤学安全性,并与开放胰十二指肠切除术（OPD）进行疗效对比。方法回顾性分析2012年1月至2013年6月中山大学附属第三医院胃肠外科收治并行胰十二指肠切除术患者的临床资料,根据所行术式分为LPD组和OPD组,对比分析手术时间、术中出血量、清扫淋巴结数目、术后第1天腹腔引流量、术后排气时间、恢复流质饮食时间、术后发热天数、术后住院天数、术后并发症发生率、1年生存率和复发率等指标。结果两组患者性别、年龄、ASA分级、手术时间、清扫淋巴结数目、病理分期、术后发热天数、术后引流管拔除时间、术后并发症发生情况以及术后1年生存率和肿瘤复发情况等指标差异均无统计学意义（P＞0．05）。而LPD组相比OPD组,术中出血量[（168．2±87．4） ml比（353．5±140．1） ml,P＝0．000]及术后第1天腹腔引流量[（157．7±69．7） ml比（289．1±197．0） ml,P＝0．039]减少,术后排气时间[（4．1±0．9） d比（6．6±3．4） d,P＝0．024]、恢复流质饮食时间[（5．8±1．3） d比（8．2±3．5） d,P＝0．040]、下床活动时间[（3．6±1．4） d比（6．2±1．5） d,P＝0．000]和术后住院天数[（17．0±2．2） d比（25．7±13．8） d, P＝0．047）明显缩短。结论与传统开放手术相比,LPD能够保证肿瘤根治性切除和手术安全的同时,在减少术中出血和促进术后恢复过程方面具有明显优势。     

Impact of hospital case volume on short-term outcome after laparoscopic operation for colonic cancer

Background High hospital case volume has been associated with improved outcome after open operation for colorectal malignancies.Methods To assess the impact of hospital case volume on short-term outcome after laparoscopic operation for colon cancer, we conducted an analysis of patients who underwent laparoscopic colon resection within the COlon Cancer Laparoscopic or Open Resection (COLOR) trial.Results A total of 536 patients with adenocarcinoma of the colon were included in the analysis. Median operating time was 240, 210 and 188 min in centers with low, medium, and high case volumes, respectively (p < 0.001). A significant difference in conversion rate was observed among low, medium, and high case volume hospitals (24% vs 24% vs 9%; p < 0.001). A higher number of lymph nodes were harvested at high case volume hospitals (p < 0.001). After operation, fewer complications (p = 0.006) and a shorter hospital stay (p < 0.001) were observed in patients treated at hospitals with high caseloads.Conclusions Laparoscopic operation for colon cancer at hospitals with high caseloads appears to be associated with improved short-term results.     

腹腔镜与开腹手术治疗结直肠癌的近期疗效观察

目的:对比分析腹腔镜与开腹手术治疗结直肠癌的近期临床疗效。方法:回顾分析2012年1月至2013年1月收治的91例结直肠癌患者的临床资料,根据住院号将患者分为两组,45例行开腹手术(开腹组),46例行腹腔镜手术(腹腔镜组),对比两组患者切口长度、手术时间、术中出血量、术后住院时间、术后切口感染率、术后止痛药使用人次、排气时间及淋巴结清扫数量等。采用SPSS 19.0统计软件进行统计分析。结果:腹腔镜组切口长度、术中出血量、手术时间、术后住院时间及术后止痛药应用人次优于开腹组,差异有统计学意义(P<0.05)。淋巴结清扫数量、排气时间、切口感染率两组相比差异无统计学意义(P>0.05)。结论:相较传统开腹手术,腹腔镜结直肠癌手术是安全、可行的,可取得与开腹手术相当的淋巴结清扫范围,且具有患者创伤小、术后疼痛轻等优点,但其远期效果尚需进一步研究。     

手助腹腔镜与开腹肝切除术的临床对照研究

目的：探讨手助腹腔镜肝切除术的可行性及微创性。方法：随机将60例肝切除患者分为两组,30例行手助腹腔镜肝切除术,30例行开腹肝切除术,比较两组的手术时间、术中出血量、切口长度、术后肛门排气时间、术后住院时间、术后并发症、术前及术后第1、4、7天C反应蛋白（CRP）及中性粒细胞的动态变化。结果：手助腹腔镜组与开腹组的平均手术时间（114.3minvs.105.8min）和切缘距肿瘤边缘（3.22cmvs.3.33cm）差异无统计学意义（P〉0.05）。手助腹腔镜组术中平均出血量明显少于开腹组（212mlvs.376.5ml,P〈0.05）,切口长度差异有统计学意义（6.95cmvs.22cm,P〈0.01）。手助腹腔镜组术后胃肠功能恢复时间明显早于开腹组（术后肛门排气时间2.34dvs.3.48d,P〈0.05）。手助腹腔镜组住院时间明显短于开腹组（8.35dvs.10.8d,P〈0.01）。手助腹腔镜组与开腹组均无严重并发症发生。两组术后第7天CRP值比较有显著差异（23.23vs.63.35,P〈0.05）。两组于术后第4天中性粒细胞值比较有显著差异（6.45vs.9.51,P〈0.05）。结论：手助腹腔镜肝切除安全可行,并且具有创伤小、术后康复快等特点,是值得选择的微创肝切除方式。     

A dermoid cyst fistulating with the transverse colon

We present a rare case of fistulation of a dermoid cyst with the transverse colon. We illustrate how an infected dermoid cyst can be diagnosed as an appendix abscess although the management of these is quite different. The general surgeon should be aware of this as a differential diagnosis for an appendix abscess.