结直肠癌伴不可切除的同时性肝转移的腹腔镜治疗

目的:探讨结直肠癌伴有同时性不可切除肝转移灶的腹腔镜治疗的可行性及临床应用价值。方法:回顾分析2011年6月至2012年12月31例结直肠癌伴不可切除的同时性肝转移患者的临床资料及随访结果。按原发灶手术切除方式分为两组,A组行开腹手术切除结直肠癌原发灶(n=18),B组行腹腔镜手术(n=13)。术后均采取mFOLFOX6方案化疗。对比分析两组患者手术时间、术中出血量、术后排气时间、术后住院时间、术后接受首次化疗时间及治疗效果。结果:31例均成功施行结直肠癌切除术,腹腔镜组无一例中转开腹及严重并发症发生。术后患者行mFOLFOX6方案化疗至少2个周期。经统计学分析发现,两组患者手术时间、治疗效果差异无统计学意义(P>0.05),但腹腔镜组术中出血量明显减少(P<0.01),术后排气时间明显缩短(P<0.05),术后住院时间明显减少(P<0.05),术后接受首次化疗的时间明显缩短(P<0.05)。结论:对于不可切除的同时性结直肠癌肝转移患者,行腹腔镜原发肿瘤切除是安全、可行的;与开腹手术相比,腹腔镜手术治疗结直肠癌伴不可切除的同时性肝转移,在切除原发灶的手术中具有出血量少、创伤小、术后肠功能恢复快、住院时间明显缩短并促进术后早期化疗等优势。腹腔镜手术对原发肿瘤及转移灶的治疗效果与开腹手术无明显差别,具有良好的临床应用价值。

The laparoscopic treatment of the colorectal cancer with unresectable synchronous liver metastases

Objective:To investigate the feasibility and clinical value of laparoscopic treatment of colorectal cancer with the unresectable synchronous liver metastases.Methods:Between Jun.2011 and Dec.2012,the clinical data and follow-up results of 31 patients with unresectable synchronous colorectal liver metastases in our department were retrospectively analyzed.According to the different resective methods of primary tumor,patients were divided into two groups.Group A was open surgery group(n=18) which choosing traditional surgical resection of the primary colorectal tumor;Group B was laparoscopic group(n=13) which choosing laparoscopic resection of the primary tumor.All of patients accepted postoperative mFOLFOX6 chemotherapy.The mean operative time,blood loss,postoperative exhaust time,postoperative hospital stay,postoperative chemotherapy day and therapeutic effect between two groups were compared.Results:Colorectal cancer resections were performed successfully on 31 patients and the conversion to open surgery did not occur in laparoscopic group.And there were no severe complications in both groups.All of patients accepted postoperative mFOLFOX6 chemotherapy with at least 2 cycles.With the statistical analysis of two groups' data,there was no significant difference in operative time(P>0.05).However,in the laparoscopic group,the amount of blood loss was significantly less(P<0.01),the postoperative exhaust time was significantly shorter,the postoperative hospital stay was significantly reduced(P<0.05) and the time of postoperative chemotherapy was significantly in advance(P<0.05).Comparing the therapeutic effect,there was no significant difference between these two groups(P>0.05).Conclusions:Laparoscopic resection of primary tumor is safe and feasible for colorectal cancer with the unresectable synchronous liver metastases.Compared to open surgery,laparoscopic surgery for colorectal cancer with unresectable synchronous liver metastases has the advantages of less blood loss,smaller trauma,faster recovery of postoperative bowel function,significantly shorter hospital stay time and promoting earlier postoperative chemotherapy in the surgical resection of primary tumor.There is no significant difference in the therapeutic effect of the primary tumor and metastases between two groups and the laparoscopic surgery has nice clinical value.