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摘要:
目的 评价腹腔镜结肠癌根治性切除术治疗Ⅲ期结肠癌患者的临床疗效和长期预后。 方法 2007年1月至2012年12月北京协和医院基本外科结直肠专业组收治的169例Ⅲ期结肠癌患者分为腹腔镜组75例和开腹组94例。比较两组患者的临床病理特征以及5年局部复发率、总生存率和无病生存率等长期预后结果。 结果 腹腔镜组手术时间显著长于开腹组[(171.3±43.2)min比(132.7±60.4)min, P < 0.001], 但是术中出血量较少[(86.3±61.7)ml比(109.8±74.6)ml, P=0.030]。腹腔镜组检出淋巴结数目显著多于开腹组(23.3±12.2比19.3±9.6, P=0.022)。腹腔镜组和开腹组患者的累积局部复发率分别为6.7%和8.5%;5年总生存率分别为73.6%和58.8%;5年无病生存率分别为61.6%和56.3%;两组差异均无统计学意义(P > 0.05)。 结论 腹腔镜手术对于治疗Ⅲ期结肠癌安全可行, 其长期肿瘤学疗效不劣于传统开腹手术。 Abstract:Objective To investigate the clinical efficacy and long-term outcomes of laparoscopic radical resection for stage Ⅲ colon cancer. Methods A total of 169 stage Ⅲ colon cancer patients treated with laparoscopic surgery (n=75) or open surgery (n=94) between January 2007 and December 2012 in Department of General Surgery, Peking Union Medical College Hospital were included. The clinicopathologic features, as well as long-term outcomes including 5-year local recurrence rate, overall survival, and disease-free survival, were compared between the two groups. Results Compared with the open surgery group, the laparoscopic surgery group had significantly longer operation time[(171.3±43.2) minutes vs. (132.7±60.4) minutes, P < 0.001], significantly less blood loss[(86.3±61.7)ml vs. (109.8±74.6)ml, P=0.030], and significantly more invaded lymph nodes detected (23.3±12.2 vs. 19.3±9.6, P=0.022). No significant difference was found between the laparoscopic surgery group and open surgery group in cumulative local recurrence rate (6.7% vs. 8.5%, P=0.876), 5-year overall survival (73.6% vs. 58.8%, P=0.317), and 5-year disease-free survival (61.6% vs. 56.3%, P=0.544). Conclusion Laparoscopic colectomy is safe and effective for stage Ⅲ colon cancer, comparable with the conventional open colectomy in terms of long-term oncological outcomes. -
Key words:
- stage Ⅲ colon cancer /
- laparoscopic surgery /
- outcome analysis
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表 1 Ⅲ期结肠癌患者临床病理特征
组别 性别(例) 年龄
(x±s，岁)术式(例) 手术时间
(x±s，min)出血量
(x±s，ml)组织分化程度(例) 淋巴结获取数目
(x±s)T分期(例) N分期(例) TNM分期(例) 男 女 右半结肠
切除术横结肠
切除术左半结肠
切除术乙状结肠
切除术高 中 低 T2 T3 T4 N1 N2 Ⅲa Ⅲb Ⅲc 腹腔镜组(n=75) 39 36 63.6±13.3 45 3 5 22 171.3±43.2 86.3±61.7 16 47 12 23.3±12.2 4 60 11 51 24 3 56 16 开腹组(n=94) 53 41 63.8±12.6 43 5 13 32 132.7±60.4 109.8±74.6 10 68 16 19.3±9.6 3 82 9 60 34 2 67 25 P值 0.680 0.929 0.341 ＜0.001 0.030 0.157 0.022 0.441 0.686 0.596 
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表 2 Ⅲ期结肠癌患者术后复发、转移情况(例)
组别 局部复发 远处转移 吻合口 腹腔内 总计 肝 骨 肺 脑 卵巢 腹膜后 总计 腹腔镜组(n=75) 0 5 5 15 1 3 1 0 1 21 开腹组(n=94) 1 7 8 21 2 5 0 1 2 29
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