内镜辅助腹腔镜手术在早期结肠癌治疗中的应用

目的 探讨内镜辅助腹腔镜(双镜)手术在早期结肠癌治疗中的应用价值.方法 回顾性分析2002年3月至2007年12月间应用双镜手术治疗55例早期结肠癌患者的临床资料.结果 53例成功实施内镜定位、腹腔镜游离结肠肠段切除术,根据术中冰冻病理切片结果追加腹腔镜根治术11例;2例(3.6%)内镜定位后因小肠胀气中转开腹.平均手术时间90(55～240)min,术中平均出血量50(10～200)ml.51例(92.7%)术后2～3 d肛门排气,术后平均住院时间为5(2～15)d,无术后并发症.术后平均随访42(3～72)个月,除1例死于心肌梗死外,其余存活至今,均无肿瘤复发转移.结论 内镜辅助腹腔镜手术可充分发挥两者的优势,是早期结肠癌有效的治疗方法之一.

Evaluation of endoscopy-assisted laparoscopic surgery in the treatment of early colon cancer

Objective To evaluate the endoscopy-assisted laparoscopic surgery in the treatment of early colon carcinoma. Methods The data of 55 early colon cancer patients, including 30 male, 25 female with mean age of 54 years(ranged 42 to 68), undergone endoscopy-assisted laparoscopic surgery at the colon were reviewed retrospectively. Results From March 2002 to December 2007, 55 early colon cancer patients were treated with endoscopy-assisted laparoscopic surgery in our institute. In 53 cases, a laparoscopic and endoscopic cooperative bowel segment resection was performed at first. Of these 53 patients, 11 cases then received laparoscopic and endoscopic cooperative radical anatomical resection according to the result of frozen section. Two cases were transferred to open surgery because of small intestinal inflation after endoscopic location. The mean operative time of cooperation was 90 min (55-240 min), and the mean blood loss was 50 ml (10-200 ml). In 51 cases (92.7%), the time for flatus passage was 2 to 3 days. The mean postoperative hospital stay was 5 d(2-15 d). No postoperative complications were found. Follow-up data were obtained by clinical examination and personal communication via telephone. The median follow-up was 42 months (ranged 3-72). Most of the patients were alive except one case died of myocardial infarction during the follow-up period. None of the patients with early colon cancer treated by the cooperative surgery had relapse or metastasis. Two cases of T1N1Mx underwent adjuvant chemotherapy. Conclusions Endoscopy-assisted laparoscopic surgery offers a minimal-invasive and safe therapeutic approach for early colon cancer. The early colon cancer may be a good indication for endoscopy-assisted laparoscopic surgery when the endoscopic mucosal resection is inadequate.