老年人结直肠癌患者腹腔镜与开腹手术效果的比较

结直肠癌患病率已占全部恶性肿瘤的第3位,病死率位于恶性肿瘤致死原因的第5位[1].近10余年腹腔镜结直肠癌手术发展较迅速,其疗效已得到肯定[2],与开腹手术相比,其对机体创伤及营养状况影响小,有利于患者术后康复,应用越来越广泛.腹腔镜结直肠癌根治术具有的创伤小、出血少、恢复快等优点得到广泛的认同[3].本研究对老年结直肠癌患者行腹腔镜结直肠癌根治术与开腹手术的疗效进行分析.     

80岁以上高龄结直肠癌患者的手术风险评估及生存分析

目的 评估80岁以上高龄结直肠癌患者的手术风险和疗效.方法 回顾性分析1987年12月至2005年6月99例高龄(80～91岁)结直肠癌患者的临床病理资料,分析患者的合并症、并发症、死亡率以及生存结果.对患者进行随访1～136个月,平均45.12个月.结果 99例患者中,合并症发生率为43.4%(43/99),并发症为10.1%(10/99),手术死亡率为0.80例患者完成随访,3年总生存率和无病生存率分别为64.3%和61.1%;5年总生存率和无病生存率分别为52.8%和52.1%.单因素生存分析显示手术的根治性、肿瘤组织分化程度、脉管内癌栓、分期和并发症是影响生存的预后因素.多因素生存分析证实只有手术的根治性才是影响预后的重要指标.结论 高龄结直肠癌患者具有高合并症风险,但是通过积极的干预和规范的手术操作,仍能获得良好的生存结果.     

80岁以上高龄结直肠癌患者的手术风险评估及生存分析

目的 评估80岁以上高龄结直肠癌患者的手术风险和疗效.方法 回顾性分析1987年12月至2005年6月99例高龄(80～91岁)结直肠癌患者的临床病理资料,分析患者的合并症、并发症、死亡率以及生存结果.对患者进行随访1～136个月,平均45.12个月.结果 99例患者中,合并症发生率为43.4%(43/99),并发症为10.1%(10/99),手术死亡率为0.80例患者完成随访,3年总生存率和无病生存率分别为64.3%和61.1%;5年总生存率和无病生存率分别为52.8%和52.1%.单因素生存分析显示手术的根治性、肿瘤组织分化程度、脉管内癌栓、分期和并发症是影响生存的预后因素.多因素生存分析证实只有手术的根治性才是影响预后的重要指标.结论 高龄结直肠癌患者具有高合并症风险,但是通过积极的干预和规范的手术操作,仍能获得良好的生存结果.     

80岁以上高龄结直肠癌患者的手术风险评估及生存分析

目的 评估80岁以上高龄结直肠癌患者的手术风险和疗效.方法 回顾性分析1987年12月至2005年6月99例高龄(80～91岁)结直肠癌患者的临床病理资料,分析患者的合并症、并发症、死亡率以及生存结果.对患者进行随访1～136个月,平均45.12个月.结果 99例患者中,合并症发生率为43.4%(43/99),并发症为10.1%(10/99),手术死亡率为0.80例患者完成随访,3年总生存率和无病生存率分别为64.3%和61.1%;5年总生存率和无病生存率分别为52.8%和52.1%.单因素生存分析显示手术的根治性、肿瘤组织分化程度、脉管内癌栓、分期和并发症是影响生存的预后因素.多因素生存分析证实只有手术的根治性才是影响预后的重要指标.结论 高龄结直肠癌患者具有高合并症风险,但是通过积极的干预和规范的手术操作,仍能获得良好的生存结果.     

腹腔镜联合快速康复结直肠外科手术在老年人结直肠癌治疗中的近期疗效分析

目的 评估70岁以上老年结直肠癌患者接受腹腔镜联合快速康复结直肠外科(FTCS)治疗的安全性、可行性. 方法 将123例老年结直肠癌患者,随机分为腹腔镜+ FTCS组(41例)、腹腔镜组(41例)和开腹组(41例).比较患者手术效果指标,康复指标以及术后并发症等. 结果 腹腔镜+FTCS组与单独腔镜组或开腹组比较,其失血量、手术时间、排便时间,淋巴结清扫个数等差异无统计学意义(P＞0.05);腹腔镜+FTCS组较腔镜组或开腹组能够显著缩短患者下床时间、排气时间、首次流质时间以及住院时间(P＜0.05).各组术后并发症发生率分别为腹腔镜+ FTCS组:12.2％(5/41);腹腔镜组:34.1％(14/41);开腹组:68.3％(28/41).腹腔镜+FTCS组患者并发症发生率低于腹腔镜组和开腹组(x2 =5.549,P=0.018;x2 =28.826,P＜0.01),腹腔镜组患者并发症发生率显著低于开腹组(x2 =9.567,P=0.002). 结论 腹腔镜联合FTCS治疗方法在老年结直肠癌治疗中安全有效,是老年结直肠癌患者的理想治疗方式.     

腹腔镜辅助结直肠癌根治术在老年患者中的应用

目的 探讨腹腔镜辅助结直肠癌根治术在老年结直肠癌患者中的应用优势.方法 27例70岁以上结直肠癌患者,行传统开腹结直肠癌根治术者15例（A组）,行腹腔镜辅助结直肠癌根治术者12例（B组）.分别从手术时间与出血量、胃肠功能恢复时间及住院时间等方面对两组进行对比分析.结果 与A组比较,B组手术时间短、术中出血量少、术后住院天数少、术后胃肠道功能恢复时间短（P均＜0.05）.结论 腹腔镜辅助结直肠癌根治术应用于老年直肠癌,能预防和降低并发症的发生率,缩短住院时间,提高患者生活质量.     

基层医院开展腹腔镜下结直肠癌手术的临床应用(附10例报道)

目的探讨腹腔镜结直肠手术的临床应用价值。方法分析运用腹腔镜技术,按开放手术原则治疗结直肠癌10例的临床资料,其中右半结肠切除术2例,乙状结肠切除术2例,直肠癌行直肠前切除术(Dixon术)2例,Miles术3例。乙状结肠造瘘术1例。结果 10例手术均成功,1例因直肠中段癌合并肝左叶孤立转移癌,行Dixon术及开腹行肝左叶切除术。平均手术时间215 min,术中平均失血305 ml。术后肠蠕动恢复平均3.4 d,无术后出血、吻合口瘘等并发症。随访6～44月,2例因腹腔内广泛转移,于术后12个月及31个月死亡。1例肝脏转移瘤切除者于术后18个月因肝脓肿死亡,1例Miles术后28个月会阴部软组织种植转移,再次手术局部扩大切除随访12月无异常。结论腹腔镜结直肠手术安全可行,严格掌握手术适应证,熟练的腹腔镜手术技术和丰富的开腹结直肠手术经验是完成此类手术的关键     

辅助小切口腹腔镜在结直肠肿瘤手术中的应用

我院于2003年1月开始开展辅助小切口腹腔镜大肠肿瘤手术共23例,与同期传统开腹手术比较,具有手术视野清晰,损伤小,术后疼痛轻,下床活动早,肛门排气早,术后住院时间短,费用低等特点.     

腹腔镜结直肠肿瘤手术术前定位方法的应用现状

腹腔镜微创手术是目前治疗结直肠肿瘤最常见的手术方式,由于其较好的短期疗效,越来越受到中青年医师的青睐.但腹腔镜手术缺乏传统开放手术的直接触感,往往不能对较小的肿瘤精确定位,进而导致手术难度增加,手术时间延长等不良后果,因此术前准确定位是选择腹腔镜结直肠肿瘤手术的前提条件.本文就临床常用的肠道肿瘤定位方法结合相关文献及本...     

术前内镜下自体血标记定位应用于腹腔镜结直肠肿瘤手术的临床效果分析

为评价内镜下自体血标记定位在腹腔镜结直肠肿瘤术前应用的临床价值,回顾分析2019年1月—2021年1月在同济大学附属东方医院行结肠镜下自体血定位并随后行腹腔镜手术的结直肠肿瘤患者资料30例。腹腔镜手术中根据结肠浆膜面局部红色标记判断病灶所在位置。术中探查评估染色清晰度,观察有无注射自体血泄漏情况。所有患者在结肠镜下顺利完成自体血定位,无出血、穿孔和发热等并发症。腹腔镜探查可见清晰的自体血染色部位,未见染色弥散、泄漏污染术野情况。术后病理证实标本切缘阴性。说明经结肠镜下注射自体血是一种理想的腹腔镜结直肠肿瘤手术前病灶定位方法,安全有效,值得临床推广。     

Controversy of hand-assisted laparoscopic colorectal surgery

Laparoscopically assisted colorectal procedures are time-consuming and technically demanding and hence have a long steep learning curve. In the technical demand, surgeons need to handle a long mobile organ, the colon, and have to operate on multiple abdominal quadrants, most of the time with the need to secure multiple mesenteric vessels. Therefore, a new surgical innovation called hand-assisted laparoscopic surgery (HALS) was introduced in the mid 1990s as a useful alternative to totally laparoscopic procedures. This hybrid operation allows the surgeon to introduce the non-dominant hand into the abdominal cavity through a special hand port while maintaining the pneumoperitoneum. A hand in the abdomen can restore the tactile sensation which is usually lacking in laparoscopic procedures. It also improves the eye-to-hand coordination, allows the hand to be used for blunt dissection or retraction and also permits rapid control of unexpected bleeding. All of those factors can contribute tremendously to reducing the operative time. Moreover, this procedure is also considered as a hybrid procedure that combines the advantages of both minimally invasive and conventional open surgery. Nevertheless, the exact role of HALS in colorectal surgery has not been well defined during the advanced totally laparoscopic procedures. This article reviews the current status of hand-assisted laparoscopic colorectal surgery as a minimally invasive procedure in the era of laparoscopic surgery.     

三孔法腹腔镜结直肠癌NOSES术

目的探讨三孔法腹腔镜结直肠癌经自然腔道取标本手术（NOSES）的临床可行性。 方法回顾分析中山大学附属第一医院本医疗组2021年10月至2021年12月采用单人三孔腹腔镜乙状结肠癌或高位直肠癌根治术（NOSES术）的8例患者临床资料,分析手术时间、术中出血量、术后排气时间、术中淋巴结清扫数量、术后并发症、住院时间等情况。 结果8例患者均顺利完成手术,平均手术时间（170.3±38.6）分钟,平均术中出血量（43.8±11.9）mL,平均术后排气时间（42.0±24.9）小时,平均淋巴结清扫数量（13.6±9.5）颗,平均住院时间（13.4±3.9）天,术后无并发症发生。 结论由1名外科医生和1名扶镜手实施的三孔腹腔镜手术似乎是治疗结直肠癌患者的一种可行且安全的手术选择,能达到相同的根治效果,并发症并未增多。     

Evolution and future of laparoscopic colorectal surgery

The advances of laparoscopic surgery since the early 1990s have caused one of the largest technical revolutions in medicine since the detection of antibiotics (1922, Flemming), the discovery of DNA structure (1953, Watson and Crick), and solid organ transplantation (1954, Murray). Perseverance through a rocky start and increased familiarity with the chop-stick surgery in conjunction with technical refinements has resulted in a rapid expansion of the indications for minimally invasive surgery. Procedure-related factors initially contributed to this success and included the improved postoperative recovery and cosmesis, fewer wound complications, lower risk for incisional hernias and for subsequent adhesion-related small bowel obstructions; the major breakthrough however came with favorable long-term outcomes data on oncological parameters. The future will have to determine the specific role of various technical approaches, define prognostic factors of success and true progress, and consider directing further innovation while potentially limiting approaches that do not add to patient outcomes.     

Systematic review of emergent laparoscopic colorectal surgery for benign and malignant disease

Laparoscopic surgery has become well established in the management of both and malignant colorectal disease.The last decade has seen increasing numbers of surgeons trained to a high standard in minimallyinvasive surgery.However there has not been the same enthusiasm for the use of laparoscopy in emergency colorectal surgery.There is a perception that emergent surgery is technically more difficult and may lead to worse outcomes.The present review aims to provide a comprehensive and critical appraisal of the available literature on the use of laparoscopic colorectal surgery(LCS)in the emergency setting.The literature is broadly divided by the underlying pathology;that is,inflammatory bowel disease,diverticulitis and malignant obstruction.There were no randomized trials and the majority of the studies were case-matched series or comparative studies.The overall trend was that LCS is associated with shorter hospital stay,par or fewer complications but an increased operating time.Emergency LCS can be safely undertaken for both benign and malignant disease providing there is appropriate patient selection,the surgeon is adequately experienced and there are sufficient resources to allow for a potentially more complex operation.     

Three-dimensional computed tomography in laparoscopic surgery for colorectal carcinoma

AIM: To evaluate the usefulness of three-dimensional computed tomography (3DCT) in laparoscopic surgery for colorectal carcinoma. METHODS: Seventy-two patients with colorectal cancer who underwent curative operation at our hospital were enrolled in this study. They were classified into two groups by operative procedures. Sixteen patients underwent laparoscopic surgery, laparoscopic group (LG), while 56 patients underwent conventional open surgery, open group (OG). At our institution, contrast-enhanced CT is routinely performed as part of intra-abdominal screening and the 3D images of the major regional vessels are described. We have previously described about the preoperative visualization of the inferior mesenteric artery (IMA) by 3DCT. This time we newly acquired 3D images of the superior mesenteric artery (SMA)/superior mesenteric vein (SMV), ileocecal artery (ICA), middle colic artery (MCA), and inferior mesenteric vein (IMV). We have compared our two study groups with regard to five items, including clinical anastomotic leakage. We have discussed here the role of 3DCT in laparoscopic surgery for colorectal carcinoma. RESULTS: The mean length of the incision in LG was 4.625+/-0.89 cm, which was significantly shorter than that in OG (P<0.001). The association between ICA and SMV and SMA was described in the right-sided colectomy. The preoperative imaging of IMA and IMV was created in the rectosigmoidectomy. There was no significant difference in anastomotic leakage between the two groups, but no patients in LG experienced anastomotic leakage. CONCLUSION: Most of the patients are satisfied with the shorter incisional length following laparoscopic surgery. Preoperative visualization of the major regional vessels may be helpful for the secure treatment of the anastomosis in laparoscopic surgery for colorectal carcinoma.     

Single-incision laparoscopic colorectal surgery for cancer: State of art

A number of clinical trials have demonstrated that the laparoscopic approach for colorectal cancer resection provides the same oncologic results as open surgery along with all clinical benefits of minimally invasive surgery. During the last years, a great effort has been made to research for minimizing parietal trauma, yet for cosmetic reasons and in order to further reduce surgery-related pain and morbidity. New techniques, such as natural orifice transluminal endoscopic surgery (NOTES) and single-incision laparoscopy (SIL) have been developed in order to reach the goal of “scarless” surgery. Although NOTES may seem not fully suitable or safe for advanced procedures, such as colectomies, SIL is currently regarded as the next major advance in the progress of minimally invasive surgical approaches to colorectal disease that is more feasible in generalized use. The small incision through the umbilicus allows surgeons to use familiar standard laparoscopic instruments and thus, perform even complex procedures which require extraction of large surgical specimens or intestinal anastomosis. The cosmetic result from SIL is also better because the only incision is made through the umbilicus which can hide the wound effectively after operation. However, SIL raises a number of specific new challenges compared with the laparoscopic conventional approach. A reduced capacity for triangulation, the repeated conflicts between the shafts of the instruments and the difficulties to achieve a correct exposure of the operative field are the most claimed issues. The use therefore of this new approach for complex colorectal procedures might understandingly be viewed as difficult to implement, especially for oncologic cases.     

腹腔镜手术与开腹手术治疗结直肠癌的临床疗效比较

目的比较腹腔镜手术与开腹手术治疗结直肠癌患者的临床疗效。方法选取2012-02~2015-10该院收治的结直肠癌患者76例,根据手术方式的不同分为腹腔镜组(n=39)和开腹组(n=37)。腹腔镜组采用腹腔镜手术治疗,开腹组采用传统开腹手术治疗,比较两组患者切口长度、手术时间、术中失血量、术后肛门排气时间、开始进流食时间、下床活动时间、住院时间、淋巴结清扫数目以及术后并发症发生情况。结果腹腔镜组切口长度、术中失血量、术后肛门排气时间、开始进流食时间、下床活动时间、住院时间均明显小于或低于开腹组,差异有统计学意义(P0.05),两组淋巴结清扫数目比较差异无统计学意义(P0.05)。腹腔镜组并发症发生率为7.69%(3/39),开腹组为27.03%(10/37),差异有统计学意义(P0.05)。结论腹腔镜下结直肠癌手术具有安全、创伤小、恢复快、并发症少等优点。     

Clinicopathological features of colorectal cancer in patients over 70 years of age

Abstract

Objective. The aim was to identify the clinical factors and tumor characteristics that predict mortality and survival in patients older than 70 years with colorectal adenocarcinoma. Material and methods . One hundred and ninety-four patients with colorectal cancer aged over 70 years were identified from a computer database and their clinical variables were analyzed by both univariate and multivariate analyses. Results. All patients underwent resective surgery, 79% radical and 21% palliative resection, and postoperative mortality was 6% being associated with the presence of postoperative complications, especially anastomotic leakage. The cumulative 5-year survival was 38%, the median survival 35 months, and the cancer-specific 5-year survival 48% and this did not differ significantly between the age groups. The recurrence rate after radical surgery was 30%, being 12, 22, 56, and 100% in Dukes classes A, B, C, and D. Kaplan-Meier estimates indicated that gender, Dukes staging, grade of tumor, number of lymph node metastasis, venous invasion, and recurrent disease were significant predictors of survival, but in the Cox regression model, only venous invasion and recurrent disease were independent prognostic factors of survival. Conclusions. Low mortality and acceptable survival can be achieved in elderly patients with colorectal cancer. Venous invasion and recurrent cancer are independent predictors of survival.