摘要
[目的]探讨追加补救腹腔镜根治手术应用于内镜黏膜下剥离术治疗T1期结直肠癌患者的安全性及有效性。[方法]回顾性分析2015年1月至2019年5月中国医学科学院肿瘤医院完成的行补救腹腔镜根治手术的内镜黏膜下剥离术治疗的T1期结直肠癌患者(补救根治术组)122例和直接行腹腔镜根治手术的T1期结直肠癌(直接根治术组)144例患者的临床资料,比较两组患者各项临床指标情况。[结果]两组患者在体质指数、ASA分级、手术部位、肿瘤分化程度、手术方式、失血量、检出淋巴结数量、首次排气排便时间和住院日无统计学差异(均P>0.05)。尽管两组术后并发症差异无统计学意义(P>0.05),但是补救根治术组吻合口瘘发生风险增高。补救根治术组中患者更年轻并且男性患者较多,首次进食时间较早,术后大体标本发现淋巴结转移风险也较高(均P<0.05)。[结论]内镜黏膜下剥离术不增加进行补救腹腔镜手术的困难程度。不过补救根治术组的淋巴结转移风险较高,同时要密切关注补救术后发生吻合口瘘的风险。但是对于非治愈性内镜黏膜下剥离术后的患者,补救手术是有益的并且有良好的近期疗效。
[Purpose] To investigate the safety and efficacy of stage T1 colorectal cancer treated with additional laporascopic-assisted surgery after endoscopic submucosal dissection. [Methods] Clinical data of 122 cases treated with additional laporascopic-assisted surgery after endoscopic submucosal dissection(additional surgery group) and 144 cases treated with laporascopic-assisted surgery alone(surgery alone group) from January 2015 to May 2019 in Cancer Hospital,Chinese Academy of Medical Science were reviewed retrospectively. [Results] There were no significant differences in body mass index(BMI),ASA classification,tumor location and histology,surgery type,blood loss,number of harvested lymph node,time to pass first flatus and stool,the incidence of postoperative complications and the length of hospital stay between two groups(P>0.05). There was a trend toward on increasing rate of anastomotic leakage in additional surgery group. Meanwhile,the risk of lymph node metastasis was higher,the time to intake was earlier and the proportion of younger and male patients was higher in additional surgery group than those in surgery alone group(P<0.05). [Conclusion] Endoscopic submucosal dissection does not increase the difficulty of additional laparoscopic-assisted surgery. This study has found that the risk of lymph node metastasis is higher in the additional surgery group and the risk of anastomotic leakage cannot be neglected. However,for patients with non-curative endoscopic submucosal dissection,additional laparoscopic-assisted surgery is beneficial and has good short-term outcomes.
作者
程璞
卢召
黄飞
张明光
陈海鹏
郑朝旭
CHENG Pu;LU Zhao;HUANG Fei;ZHANG Mingguang;CHEN Hai-peng;ZHENG Zhao-xu(National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital,Chinese Academy of Medical Science and Peking Union Medical College,Beijing 100021,China)
出处
《中国肿瘤》
CAS
CSCD
北大核心
2020年第5期396-400,共5页
China Cancer
基金
国家重点研发计划(2017YFC0908200,2017YFC0908203)
北京市朝阳区科技计划项目(CYSF-1931)
中国医学科学院医学与健康科技创新工程项目(2017-I2M-2-003)
北京市科协金桥工程种子基金(ZZ19055).
关键词
内镜黏膜下剥离术
补救手术
腹腔镜根治术
结直肠癌
近期疗效
endoscopic submucosal dissection
additional surgery
laparoscopic-assisted surgery
colorectal cancer
short-term outcome
