金属支架置入联合腹腔镜手术治疗左半结肠癌、直肠癌梗阻

目的探讨左半结肠癌、直肠癌梗阻患者支架置入后腹腔镜手术的安全性和可行性。方法2009年3月～2013年4月43例左半结肠癌、直肠癌梗阻根据患者及家属意愿选择手术方式,分为支架联合腹腔镜手术25例（支架腹腔镜组）,术中大肠灌洗一期切除吻合术18例（一期吻合组）,比较2组手术时间、住院时间、术中出血量、吻合口漏、切口感染、腹腔感染等。结果支架腹腔镜组术中出血量（40．5±20．1）ml,明显少于一期吻合组（280．8±20．6）ml（t=-38．277,P=0．000）;手术时间（135．2±25．4）rain,明显短于一期吻合组（240．4±30．5）min（t=-12．317,P=0．000）;吻合口漏0例,显著少于一期吻合组4例（Fisher’s检验,P=0．025）;切口感染0例,显著少于一期吻合组8例（Fisher’s检验,P=0．000）;腹腔感染0例,显著少于一期吻合组6例（Fisher’s检验,P=0．003）;住院时间（19．5±3．3）d与一期吻合组（20．2±8．5）d无明显差异（t=0．376,P=0．709）。2组患者术后6。12个月随访,恢复良好,无吻合口复发。结论左半结肠癌、直肠癌梗阻患者支架置入后7—10d腹腔镜手术安全可行,术后恢复快,并发症少。     

Perforative Carcinoma of Colon and Rectum

As further statistical evidence accumulates it is becoming evident that a major factor in the differing patient salvage between perforative and uncomplicated cancer of the colon and rectum is the element of infection. The absence of abdominal sepsis is undoubtedly responsible for the lessened morbidity and mortality found in the treatment of established fistulas. Surgical attention should therefore be directed first to the eradication of the primary source of infection, the perforated tumor. The safety with which an intestinal anastomosis may be made in the presence of edema and inflammation is a matter of mature judgement on the part of the operating surgeon. Postoperative suture line leakage should be avoidable. Extirpative surgery with or without anastomosis, coupled with the judicious drainage of the peritoneal cavity, antibiotic coverage, and blood volume support should continue to give improved results in the management of this distressing complication of cancer of the colon and rectum.     

Laparoscopic Pelvic Autonomic Nerve-Preserving Surgery for Sigmoid Colon Cancer

Background To test the feasibility of laparoscopic approach in performing the simultaneous pelvic autonomic nerve preservation during standard anterior resection of sigmoid colon cancer. Methods Patients meeting appropriate eligibility criteria were recruited for the present study. The surgical procedures are shown in the video. The genitourinary function was evaluated on the basis of validated questionnaires including International Prostate Symptom Score (IPSS), International Index of Erectile Function (IIEF), and Female Sexual Function Index (FSFI). Results A total of 112 patients (tumor, node, metastasis system stage I, n = 8; stage II, n = 54; stage III, n = 50; male, n = 58; female, n = 54; age [mean ± standard deviation], 55.8 ± 6.4 years) with good baseline genitourinary function were operated on with the intent of total preservation of pelvic autonomic nerves and curative resection of sigmoid colon cancer. The patients were prospectively followed (median time of follow-up, 18 months; range, 6–30 months). In patients with a successful nerve-preserving surgery (96.4%, n = 108), 104 patients completed the evaluation of urinary function. The median duration for indwelling urine Foley catheter was 3.0 days (range, 1.0–7.0 days). The voiding function after removal of the urine Foley catheter was good (IPSS, 0–7) in 98 (94.2%) patients, fair (IPSS, 8–14) in 5 (4.8%), and poor (IPSS, 15–35) in 1 (1.0%). Before and after nerve-preserving surgery, there were no significant changes of IPSS scores (3.20 ± 1.72 vs. 3.68 ± 2.82, P = .075, paired t-test) in the present patient series. Forty-four male patients completed the postoperative evaluation of sexual function, and ejaculation was ranked as good in 40 (90.9%), fair (decrease in ejaculatory amounts) in 3 (6.8%), and poor (retrograde ejaculation, failure of ejaculation) in 1 (2.3%), whereas the potency was good (IIEF, 60–75) in 41 (93.2%), fair (IIEF, 44–59) in 2 (4.5%), and poor (IIEF, 5–43) in 1 (2.3%). Moreover, before and after a successful nerve-preserving operation, there were no significant changes of IIEF scores (72.4 ± 4.6 vs. 70.3 ± 8.4, P = .082, paired t-test). For female patients (n = 42), the postoperative sexual function was ranked as good (FSFI score, 76–95) in 36 (85.7%), fair (FSFI, 58–75) in 4 (9.5%), and poor (FSFI, 4–57) in 2 (4.8%). Furthermore, there were no significant changes of FSFI scores (89.0 ± 9.2 vs. 85.4 ± 16.4, P = .122, paired t-test) before and after successful nerve-preserving surgery. Conclusions Under laparoscopy, we can clearly identify and preserve the pelvic autonomic nerves to retain genitourinary function in most patients undergoing oncologic resection of sigmoid colon cancer. Electronic supplementary material The online version of this article (doi:) contains supplementary material, which is available to authorized users.     

结肠癌腹腔镜下切除与开腹切除的短期疗效对比

目的比较结肠癌腹腔镜辅助下切除与开腹切除的短期疗效。方法对2004年1月～2009年12月笔者所在医院行腹腔镜辅助下结肠癌根治术30例及开腹结肠癌根治术45例患者的临床资料进行回顾性分析,比较两组患者手术及术后情况。结果腹腔镜组与开腹组手术时间分别为（150.45±22.10）min和（148.56±28.55）min;切口总长度分别为（6.55±0.54）cm和（18.56±2.35）cm;出血量分别为（33.52±23.08）mL和（40.35±25.12）mL;淋巴结清除数分别为（12.53±2.36）枚和（13.24±2.05）枚;术后镇痛时间分别为（49.00±2.30）min和（89.00±9.30）min;术后下床活动时间分别为（30.85±7.09）min和（72.25±9.73）min;术后平均住院天数（6.05±1.09）d和（10.06±2.16）d;术后肛门排气时间分别为（25.08±6.89）min和（66.28±13.57）min;两组患者病理切缘均为阴性,均无术后并发症及术后死亡病例。结论腹腔镜辅助下结肠癌根治术安全可行,具有患者创伤小、术后康复快的优点,根治效果可达到开腹手术的水平。     

Initial Experience of Single-port Laparoscopic Surgery for Sigmoid Colon Cancer

Background

Single-port laparoscopic surgery has attracted attention in the field of minimally invasive colorectal surgery. We hypothesized that an experienced laparoscopic surgeon could perform single-port surgery for colon cancer eligible for conventional laparoscopic anterior resection. Our aim was to analyze our initial experience and immediate surgical outcomes of single-port anterior resection.

Methods

A total of 37 consecutive patients with presumed sigmoid colonic cancer underwent single-port anterior resection with standard laparoscopic instruments between May 2009 and June 2010. Each operation was performed by one of two experienced colorectal surgeons. A cohort of patients who had undergone conventional laparoscopic surgery (CLS) for the same duration a year earlier (August 2007 to September 2008) was used as a historical control. Patient demographics and perioperative outcomes were analyzed and compared with those of CLS.

Results

There were no significant differences in mean estimated blood loss, mean length of the resection margin, or morbidity between the two groups, but operative time for the single-port group was significantly shorter (118 ± 41 vs 140 ± 42 min; p = 0.017). Single-port laparoscopic surgery was successfully performed in 78.4 % (29/37) of the patients treated in 2010, and CLS was successfully completed in all of the patients treated the previous year (p = 0.000). The main causes of single-port surgery failure were adhesion and tumor location.

Conclusions

Single-port anterior resection is a feasible and safe procedure with immediate outcomes comparable to those of conventional laparoscopy. Further studies are required to determine the feasibility of single-port surgery for colonic tumors outside the sigmoid colon and the long-term outcome.     

Long-Term Outcomes of Laparoscopic Surgery for Advanced Transverse Colon Cancer

Background

The role of laparoscopic surgery for advanced transverse colon cancer (TCC) remains controversial, especially in terms of long-term oncologic outcomes.

Methods

This retrospective cohort study enrolled 157 consecutive patients who underwent curable resections for advanced TCC between January 2002 and June 2011 (laparoscopic-assisted colectomy (LAC), n?=?74; open colectomy (OC), n?=?83). Short-term outcomes and oncologic long-term outcomes were compared between the two groups.

Results

Compared to the OC group, patients in the LAC group had less blood loss (LAC vs. OC, 79.6?±?70.3 vs. 158.4?±?89.3 ml, p?<?0.001), faster return of bowel function (2.6?±?0.7 vs. 3.8?±?0.8 days, p?<?0.001), and shorter postoperative hospital stay (10.3?±?3.7 vs. 12.6?±?6.0 days, p?=?0.007). Conversions were required in four (5.4 %) patients. Rates of short-term complication, mortality, and long-term complication were comparable between the two groups. The median follow-up time was 54 (26–106) months in the LAC group and 58 (29–113) months in the OC group (p?=?0.407). There were no statistical differences in the rates of 5-year overall survival (73.6 vs. 71.1 %, p?=?0.397) and 5-year disease-free survival (70.5 vs. 66.7 %, p?=?0.501) between the two groups.

Conclusions

Laparoscopic surgery for advanced TCC yield short-term benefits while achieving equivalent long-term oncologic outcomes.     

腹腔镜手术与开腹手术治疗结肠癌的疗效比较

目的比较腹腔镜手术与开腹手术治疗结肠癌的疗效。方法 72例结肠癌患者随机分成腹腔镜组37例和开腹组35例。观察两组患者的手术时间、切口长度、术中出血量、术后住院时间,并以肛门恢复排气时间作为胃肠功能恢复的指标,监测患者术后并发症的情况。结果腹腔镜组患者平均手术时间较开腹组有明显增长,为(221.6±37.2)min vs.(150.9±27.8)min(P<0.05),而切口长度、术中出血量、肛门恢复排气时间、术后住院时间均优于开腹组,分别为(5.78±0.61)cm vs.(18.74±2.30)cm,(48.6±31.5)ml vs.(129.0±78.9)ml,(21.73±8.91)h vs.(67.32±12.84)h,(5.89±1.53)d vs.(12.62±2.45)d(P<0.05)。腹腔镜组并发症发生率为5.40%(2/37),明显低于开腹组的31.43%(11/35)(P<0.05)。结论腹腔镜手术治疗结肠癌具有创伤小、恢复快等优点,是一种安全有效的手术方法。