中国实用外科杂志

中国实用外科杂志

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腹腔镜联合同期开放手术与全开放手术治疗同时性结直肠癌肝转移临床对比研究

黄联盟，张    卫，孟荣贵，郝立强，刘连杰，楼    征，龚海峰，高显华，于冠宇   

  1. 海军军医大学附属长海医院肛肠外科，上海 200433
  • 出版日期:2020-05-01 发布日期:2020-05-15

  • Online:2020-05-01 Published:2020-05-15

摘要： 目的    对比腹腔镜结直肠癌切除（LCS）联合同期开放肝转移灶切除术与同期全开放切除术（TOS）治疗同时性结直肠癌肝转移（sCRLM）的临床疗效，探讨LCS联合同期开放肝转移灶切除术的安全性、短期及中长期疗效。方法    回顾性分析2010年1月至2019年3月于海军军医大学附属长海医院肛肠外科行同期切除的sCRLM病人的临床病理资料，其中84例病人行LCS联合同期开放肝转移灶切除术，108例病人行同期TOS，采用倾向得分匹配方法（PSM）对两类病人进行1∶1匹配，最终LCS组（LCS联合同期开放肝转移灶切除术）和TOS组（行同期TOS）两组分别纳入69例病人，对两组病人的临床结果进行对比分析。结果    所有病人无90 d内死亡病例。LCS组无中转开放手术病例。LCS组与TOS组相比，术后进食流质时间缩短［（3.54±1.43）d vs.（4.74±1.29）d，t=-5.186 P＜0.001］，术后住院天数减少［（8.58±4.23）d vs.（13.33±5.21）d，t=-5.880 P＜0.001］，并发症发生率降低［14例（20.3%） vs. 33例（47.8%），χ2=11.648 P=0.01］，术中出血量［（433.77±423.45）mL vs.（422.46±292.37）mL，t=0.182 P=0.855］及手术时间［（277.54±81.88）min vs.（265.80±82.56）min，t=0.839 P=0.403］ 差异无统计学意义。3年存活率差异无统计学意义（60.0% vs.54.7%，χ2=1.979, P=0.160），术后无瘤存活率差异无统计学意义（χ2=3.542，P=0.076）。结论    LCS联合同期开放肝转移灶切除术用于治疗sCRLM安全可行，相比传统同期TOS，短期疗效更优，且不影响中长期肿瘤学预后。

关键词: 结直肠癌, 肝转移, 同期切除, 腹腔镜

Abstract: Comparison of laparoscopic colorectal resection combined with simultaneous open hepatectomy with totally open surgery for synchronous colorectal liver metastases        HUANG Lian-meng，ZHANG Wei，MENG Rong-gui，et al. Department of Colorectal Surgery, Changhai Hospital Affiliated to the Naval Military Medical University, Shanghai 200433, China
Corresponding author：ZHANG Wei，E-mail：weizhang2000cn@163.com
Abstract    Objective    To compare the clinical effect of synchronous colorectal liver metastases (sCRLM) patients who underwent laparoscopic colorectal surgery (LCS) combined with simultaneous open hepatectomy with the results of the tumor resection performed by totally open surgery (TOS),and explore the safety,therapeutic effect of medium and long term. Methods    The clinicopathologic data of patients with sCRLM treated by simultaneous resection in Department of Colorectal Surgery ，Changhai Hospital Affliated to the Naval Military Medical University from January 2010 to March 2019 were analyzed retrospectively. All the patients included 84 patients underwent LCS combined with simultaneous open hepatectomy and 108 patients underwent TOS. Sixty nine patients were selected in each group by using 1∶1 matching of PSM, and the clinical outcomes between the LCS group (patients underwent LCS combined with simultaneous open hepatectomy)and TOS group (patients underwent simultaneous TOS) were compared. Results    No patient died in 90 days. No patient in LCS group converted to open surgery and no mortality occurred. Compared with TOS group，the LCS group was associated with shorter time of fluid diet intake［（3.54±1.43）d vs.（4.74±1.29）d，t=-5.186，P＜0.001］，shorter postoperative hospital stay［（8.58±4.23）d vs.（13.33±5.21）d，t=-5.880， P＜0.001］ and reduced postoperative morbidity（20.3% vs 47.8%，χ2=11.648， P=0.01）. No significant differences in intraoperative blood loss［（433.77±423.45）mL vs.（422.46±292.37）mL，t=0.182，P=0.855］ and operative time［（277.54±81.88）min vs.（265.80±82.56）min，t=0.839，P=0.403］ were observed. The two groups did not differ significantly in terms of the 3-year overall survival rate (60.0% vs.54.7%，χ2=1.979，P=0.160) and disease-free survival rate (χ2=3.542，P=0.076). Conclusion    LCS combined with simultaneous open hepatectomy for sCRLM was feasible and safe. Compared with simultaneous TOS, the short-term effect is favorable and does not affect the medium and long term oncologic outcomes.

Key words: colorectal cancer, liver metastases, simultaneous resection；laparoscopy