• 南方醫(yī)科大學(xué)南方醫(yī)院普外科(廣州 510515);

目的  評價腹腔鏡和同期開腹直腸癌根治術(shù)在腫瘤學(xué)結(jié)果方面的差異。方法  分析南方醫(yī)院2003年1月至2008年12月期間520例行直腸癌根治術(shù)的TNM Ⅰ～Ⅲ期病例的臨床隨訪資料，其中腹腔鏡組186例，開腹組334例，對2組術(shù)后復(fù)發(fā)、生存等腫瘤學(xué)結(jié)果進行比較。結(jié)果  腹腔鏡組和開腹組基本臨床病理特征及輔助治療情況具有均衡可比性。2組平均隨訪30.3個月。腹腔鏡組與開腹組比較，3年累積生存率為83%比80%，遠處轉(zhuǎn)移率為12.5%比15.6%，戳孔/切口癌轉(zhuǎn)移率為0.6%比0，差異均無統(tǒng)計學(xué)意義(P gt;0.05)； 局部復(fù)發(fā)率為4.8%比10.7%，3年累積無病生存率為81%比68%，差異均具有統(tǒng)計學(xué)意義(P lt;0.05)。生存分析顯示，累積生存率2組差異無統(tǒng)計學(xué)意義(P=0.142)，而累積無病生存率腹腔鏡組則顯著高于開腹組(P=0.010)。Ⅰ或Ⅱ期病例中2組局部復(fù)發(fā)率、遠處轉(zhuǎn)移率、累積生存率及累積無病生存率的差異均無統(tǒng)計學(xué)意義(P gt;0.05); Ⅲ期病例遠處轉(zhuǎn)移率、累積生存率差異亦無統(tǒng)計學(xué)意義(P gt;0.05)，但Ⅲ期病例腹腔鏡組局部復(fù)發(fā)率顯著低于開腹組(6.8%比17.7%，P=0.047)，累積無病生存率則顯著高于開腹組(P=0.045)。結(jié)論  腹腔鏡直腸癌根治術(shù)可以達到甚至優(yōu)于同期開腹根治術(shù)的腫瘤學(xué)結(jié)果，提示針對直腸癌的腹腔鏡外科前瞻性隨機對照研究的可行性和必要性。

引用本文： 梁耀澤,余江,張策,王亞楠,胡彥鋒,甄莉,程俠,朱正鵬,李國新. 腹腔鏡與同期開腹直腸癌根治術(shù)后腫瘤學(xué)結(jié)果對比研究. 中國普外基礎(chǔ)與臨床雜志, 2010, 17(6): 591-595. doi: 復(fù)制

1. Guillou PJ, Quirke P, Thorpe H, et al. Short-term endpoints of conventional versus laparoscopic-assisted surgery in patients with colorectal cancer (MRC CLASICC trial): multicentre, randomised controlled trial[J]. Lancet, 2005; 365(9472): 1718-1726.
2. Morino M, Allaix ME, Giraudo G, et al. Laparoscopic versus open surgery for extraperitoneal rectal cancer: a prospective comparative study[J]. Surg Endosc, 2005; 19(11): 1460-1467.
3. Ahmad Assalia, Michel Gagner, Moshe Schein. Controversies in laparoscopic surgery [M]. Springer, 2007: 318-319.
4. 范瑩, 吳碩東, 于宏, 等. 腹腔鏡結(jié)直腸癌根治術(shù)與同期開腹手術(shù)對比的單中心回顧性研究 [J]. 中國普外基礎(chǔ)與臨床雜志, 2009; 16(5): 384-388.
5. 于永揚, 楊烈, 周總光, 等. 腹腔鏡全直腸系膜切除保肛術(shù)后生活質(zhì)量評估 [J]. 中國普外基礎(chǔ)與臨床雜志, 2007; 14(5): 524-529.
6. Clinical Outcomes of Surgical Therapy Study Group. A comparison of laparoscopically assisted and open colectomy for colon cancer[J]. N Engl J Med, 2004; 350(20): 2050-2059.
7. 汪建平. 重視結(jié)直腸外科手術(shù)患者術(shù)后生存質(zhì)量的提高 [J]. 中國普外基礎(chǔ)與臨床雜志, 2007; 14(6): 625-627.
8. 直腸癌臨床實踐指南 2009年(美國版), Http://www.NCCN.com.
9. 鄭民華. 腹腔鏡結(jié)腸癌根治術(shù)的原則與評價 [J]. 中華外科雜志, 2005; 43(17): 1105-1106.
10. 牟一平, 楊鵬, 嚴(yán)加費, 等. 腹腔鏡結(jié)腸癌根治術(shù)的臨床療效評估 [J]. 中華外科雜志, 2006; 44(9): 581-583.
11. Lacy AM, García-Valdecasas JC, Delgado S, et al. Laparoscopy-assisted colectomy versus open colectomy for treatment of non-metastatic colon cancer: a randomised trial [J]. Lancet, 2002; 359(9325): 2224-2229.
12. Ng SS, Leung KL, Lee JF, et al. Laparoscopic-assisted versus open abdominoperineal resection for low rectal cancer: a prospective randomized trial [J]. Ann Surg Oncol, 2008; 15(9): 2418-2425.
13. Moore E, Heald RJ, Cecil TD, et al. Almost all five year disease free survivors are cured following rectal cancer surgery, but longer term follow-up detects some late local and systemic recurrences [J]. Colorectal Dis, 2005; 7(4): 403-405.
14. 池畔, 林惠銘, 陳燕昌, 等. 兩種直腸癌根治術(shù)應(yīng)用于全直腸系膜切除術(shù)后局部復(fù)發(fā)率的比較 [J]. 中華外科雜志, 2002; 40(11): 820-821.
15. 鄭民華, 胡艷艷, 陸愛國, 等. 腹腔鏡與開腹直腸全系膜切除術(shù)治療低位直腸癌的臨床對比研究 [J]. 中華胃腸外科雜志, 2004; 7(3): 177-180.
16. Enker WE. Mesorectal excision (TME) in the operative treatment of rectal cancer [J]. Int J Surg Investig, 1999; 1(3): 253-255.
17. 鄭民華, 馬君俊. 腹腔鏡外科在爭議中發(fā)展 [J].中國普外基礎(chǔ)與臨床雜志, 2007; 14(5): 503-505.
18. 吳東波, 黃順榮, 吳鴻根, 等. 改良腹腔鏡Dixon手術(shù)和開腹Dixon手術(shù)的臨床對照研究(附58例報道) [J].中國普外基礎(chǔ)與臨床雜志, 2009; 16(3): 211-214.
19. Sargent D, Wieand S, Goldberg R, et al． 3-Year DFS vs 5-year OS as an endpoint for adjuvant colon cancer studies: data from randomized trials. Rockville, Md: Food and Drug Administration. November 2003(Accessed May 10, 2004, at. http:// www.fda.gov/cder/drug/cance_endpoints/ Sargent/index.htm).
20. Hartley JE, Mehigan BJ, MacDonald AW, et al. Patterns of recurrence and survival after laparoscopic and conventional resections for colorectal carcinoma [J]. Ann Surg, 2000; 232(2): 181-186.
21. 趙剛, 肖剛, 黃雄, 等. 腹腔鏡結(jié)直腸癌根治對機體免疫狀態(tài)的影響 [J]. 中華胃腸外科雜志, 2005; 8 (5): 407-409.
  1. 1. Guillou PJ, Quirke P, Thorpe H, et al. Short-term endpoints of conventional versus laparoscopic-assisted surgery in patients with colorectal cancer (MRC CLASICC trial): multicentre, randomised controlled trial[J]. Lancet, 2005; 365(9472): 1718-1726.
  2. 2. Morino M, Allaix ME, Giraudo G, et al. Laparoscopic versus open surgery for extraperitoneal rectal cancer: a prospective comparative study[J]. Surg Endosc, 2005; 19(11): 1460-1467.
  3. 3. Ahmad Assalia, Michel Gagner, Moshe Schein. Controversies in laparoscopic surgery [M]. Springer, 2007: 318-319.
  4. 4. 范瑩, 吳碩東, 于宏, 等. 腹腔鏡結(jié)直腸癌根治術(shù)與同期開腹手術(shù)對比的單中心回顧性研究 [J]. 中國普外基礎(chǔ)與臨床雜志, 2009; 16(5): 384-388.
  5. 5. 于永揚, 楊烈, 周總光, 等. 腹腔鏡全直腸系膜切除保肛術(shù)后生活質(zhì)量評估 [J]. 中國普外基礎(chǔ)與臨床雜志, 2007; 14(5): 524-529.
  6. 6. Clinical Outcomes of Surgical Therapy Study Group. A comparison of laparoscopically assisted and open colectomy for colon cancer[J]. N Engl J Med, 2004; 350(20): 2050-2059.
  7. 7. 汪建平. 重視結(jié)直腸外科手術(shù)患者術(shù)后生存質(zhì)量的提高 [J]. 中國普外基礎(chǔ)與臨床雜志, 2007; 14(6): 625-627.
  8. 8. 直腸癌臨床實踐指南 2009年(美國版), Http://www.NCCN.com.
  9. 9. 鄭民華. 腹腔鏡結(jié)腸癌根治術(shù)的原則與評價 [J]. 中華外科雜志, 2005; 43(17): 1105-1106.
  10. 10. 牟一平, 楊鵬, 嚴(yán)加費, 等. 腹腔鏡結(jié)腸癌根治術(shù)的臨床療效評估 [J]. 中華外科雜志, 2006; 44(9): 581-583.
  11. 11. Lacy AM, García-Valdecasas JC, Delgado S, et al. Laparoscopy-assisted colectomy versus open colectomy for treatment of non-metastatic colon cancer: a randomised trial [J]. Lancet, 2002; 359(9325): 2224-2229.
  12. 12. Ng SS, Leung KL, Lee JF, et al. Laparoscopic-assisted versus open abdominoperineal resection for low rectal cancer: a prospective randomized trial [J]. Ann Surg Oncol, 2008; 15(9): 2418-2425.
  13. 13. Moore E, Heald RJ, Cecil TD, et al. Almost all five year disease free survivors are cured following rectal cancer surgery, but longer term follow-up detects some late local and systemic recurrences [J]. Colorectal Dis, 2005; 7(4): 403-405.
  14. 14. 池畔, 林惠銘, 陳燕昌, 等. 兩種直腸癌根治術(shù)應(yīng)用于全直腸系膜切除術(shù)后局部復(fù)發(fā)率的比較 [J]. 中華外科雜志, 2002; 40(11): 820-821.
  15. 15. 鄭民華, 胡艷艷, 陸愛國, 等. 腹腔鏡與開腹直腸全系膜切除術(shù)治療低位直腸癌的臨床對比研究 [J]. 中華胃腸外科雜志, 2004; 7(3): 177-180.
  16. 16. Enker WE. Mesorectal excision (TME) in the operative treatment of rectal cancer [J]. Int J Surg Investig, 1999; 1(3): 253-255.
  17. 17. 鄭民華, 馬君俊. 腹腔鏡外科在爭議中發(fā)展 [J].中國普外基礎(chǔ)與臨床雜志, 2007; 14(5): 503-505.
  18. 18. 吳東波, 黃順榮, 吳鴻根, 等. 改良腹腔鏡Dixon手術(shù)和開腹Dixon手術(shù)的臨床對照研究(附58例報道) [J].中國普外基礎(chǔ)與臨床雜志, 2009; 16(3): 211-214.
  19. 19. Sargent D, Wieand S, Goldberg R, et al． 3-Year DFS vs 5-year OS as an endpoint for adjuvant colon cancer studies: data from randomized trials. Rockville, Md: Food and Drug Administration. November 2003(Accessed May 10, 2004, at. http:// www.fda.gov/cder/drug/cance_endpoints/ Sargent/index.htm).
  20. 20. Hartley JE, Mehigan BJ, MacDonald AW, et al. Patterns of recurrence and survival after laparoscopic and conventional resections for colorectal carcinoma [J]. Ann Surg, 2000; 232(2): 181-186.
  21. 21. 趙剛, 肖剛, 黃雄, 等. 腹腔鏡結(jié)直腸癌根治對機體免疫狀態(tài)的影響 [J]. 中華胃腸外科雜志, 2005; 8 (5): 407-409.