3D腹腔镜与传统开腹手术切除结直肠癌肝转移病灶的安全性比较

3D laparoscopy versus traditional open surgery in treatment of liver metastasis of colorectal cancer

  • 摘要: 目的 比较3D腹腔镜辅助与传统开放手术在切除结直肠癌肝转移病灶的安全性和围术期指标。 方法 回顾性分析2012年5月- 2017年5月解放军总医院肝胆外科及普通外科行结直肠癌肝转移病灶切除手术患者116例的临床资料。根据手术方式分为观察组57例(行3D腹腔镜辅助肝转移灶切除术)和对照组59例(行传统开放肝转移病灶切除术)。 结果 两组患者在性别、年龄、体质量指数、病理分型等基本资料上差异无统计学意义。观察组手术时间少于对照组 (164.32±18.61) min vs (184.21±22.01) min,P=0.001,手术出血量低于对照组 (72.23±16.44) ml vs (82.32±18.74) ml,P=0.002,切口更小(7.35±1.61) cm vs (17.34±2.43) cm,P=0.001;观察组术后首次下床时间(1.3±0.6) d vs (2.2±0.8) d,P=0.001、术后住院时间(8.1±1.6) d vs (9.3±2.1) d,P=0.002均少于对照组,差异有统计学意义。观察组术后4例发生胆瘘,3例发生切口感染,4例发生出血;对照组术后5例发生胆瘘,5例发生腹腔感染,4例发生出血,均经对症治疗后治愈出院,两组术后并发症发生率差异无统计学意义(P=0.208)。 结论 与传统开放手术相比,3D腹腔镜辅助结直肠癌肝转移病灶切除手术操作安全可行。

     

    Abstract: Objective To compare the safety and perioperative parameters of 3D laparoscopy versus traditional open surgery for liver metastasis of colorectal cancer. Methods Clinical data about 116 cases who had undergone colorectal liver metastases resection in Chinese PLA General Hospital from May 2012 to May 2017 were retrospectively analyzed. The patients were divided into observation group and control group according to their different operating methods. Patients in observation group (n=57) received 3D laparoscopy, and control group (n=59) received traditional open surgery. The safety and perioperative parameters were evaluated and compared. Results There was no statistically significant difference between the two groups in baseline data, such as age, gender, BMI and pathological type. The operating time(164.32±18.61) min vs (184.21±22.01) min, P=0.001, intraoperative blood loss volume(72.23 ±16.44) ml vs (82.32±18.74) ml, P=0.002, incision length(7.35±1.61) cm vs (17.34 ±2.43) cm, P=0.001, time to ambulation(1.3±0.6) d vs (2.2±0.8) d, P=0.001 and length of hospitalization(8.1±1.6) d vs (9.3±2.1) d, P=0.002 in the observation group were all significantly less than those of control group. In observation group, biliary fi stula occurred in 4 cases, incisional infection in 3 cases and hemorrhage in 4 cases. While in control group, biliary fi stula occurred in 5 cases, abdominal infection in 5 cases and hemorrhage in 4 cases, all of which were cured and discharged after symptomatic treatment, while the difference in incidence of postoperative complications between two groups was not significant (P=0.208). Conclusion Compared with traditional open surgery, the 3D laparoscopic surgery is more safe, feasible for colorectal carcinoma with liver metastasis.

     

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