腹腔镜联合辅助化疗及内镜治疗进展期结直肠癌合并腺瘤的应用研究

目的：探讨腹腔镜结直肠癌切除术加辅助化疗加二期内镜下治疗结直肠癌合并根治术切除范围外结直肠腺瘤的临床应用价值。方法：2005年1月-2010年6月对54例进展期结直肠癌合并根治术切除范围外结直肠腺瘤（〉1．0cm）的患者（研究组）行腹腔镜结直肠癌切除术加辅助化疗（FOLFOX4方案）加二期内镜下腺瘤切除的综合治疗，对同期396例单发进展期结直肠癌患者（对照组）行腹腔镜结直肠癌切除术加辅助化疗（FOLFOX4方案）。通过并发症发生率、长期随访等评价治疗效果。结果：2组患者在年龄、性别、手术方式、手术时间、术中出血量、并发症发生率、平均住院时间、肿瘤大小、淋巴结转移、TNM分期及1、3和5年存活率差异无统计学意义（P〉O．05）。研究组辅助化疗后对合并腺瘤进行内镜下切除治疗，4例出血经保守治疗后成功止血，未发生穿孔、狭窄等严重并发症；3例患者术后病理组织学检查为腺瘤癌变，其中2例癌变局限于腺瘤中，1例癌细胞侵犯达黏膜下层，该例患者再次行腹腔镜下切除，术后随访无复发。结论：腹腔镜联合辅助化疗及内镜为合并结直肠癌根治术切除范围外腺瘤的患者提供了一种安全有效的微创治疗方法，值得临床推厂和应用。

Application of laparoscopic combined with adjuvant chemotherapy and endoscopic to treat for advanced colorectal cancer with synchronous colorectal adenoma

Objective: To evaluate the clinical application of laparoscopic combine with adjuvant chemotherapy and endoscopic to treat for advanced colorectal cancer with synchronous colorectal adenoma outside the scope of radical surgery.Methods: From January 2005 to June 2010,54 cases of patients with advanced colorectal cancer and synchronous colorectal adenomas(>1.0 cm)outside the scope of radical surgery underwent comprehensive treatment of laparoscopic colorectal resection,adjuvant chemotherapy(FOLFOX4 program)and endoscopic resection of adenomas(Study group).At the same period,96 cases of patients with solitary advanced colorectal cancer(Control group)underwent laparoscopic colorectal resection and adjuvant chemotherapy(FOLFOX4) program.The treatment effect was evaluated by computer tomography,tumor marker,endoscopy,and long-term follow-up.Results: The age,gender,surgical methods,operative time,complication rate,average length of stay,tumor size,lymph node metastasis,TNM stage and 1-year,3-year,5-year survival in two groups was no significant difference(P>0.05).Study group was performed endoscopic resection of synchronous colorectal adenoma after adjuvant chemotherapy,in which 2 cases of bleeding were successfully stopped after conservative treatment,and serious complications such as perforation and stenosis did not occurred,and 3 patients had postoperative pathology as adenoma canceration(2 cases of cancer confined to adenoma,1 case of cancer invaded into the submucosa and was underwent laparoscopic resection without recurrence during postoperative follow-up).Conclusion: The strategy of laparoscopic combined with adjuvant chemotherapy and endoscopic resection provide a safe and effective minimally invasive treatment for patients with advanced colorectal cancer and synchronous colorectal adenoma,which is worthy of clinical promotion and application.