腹腔镜手术治疗同时性胃肠道多原发癌的临床疗效

Clinical efficacy of laparoscopic resection for synchronous gastrointestinal multiple primary cancers

    摘要
  • 摘要: 目的:探讨腹腔镜手术治疗同时性胃肠道多原发癌的安全性和可行性。
    方法:回顾性分析2009年1月至2014年1月中山大学附属第三医院19例行腹腔镜手术治疗同时性胃肠道多原发癌患者的临床资料。术后通过门诊或住院复诊、电话及信件方式随访，随访时间截至2014年4月或患者死亡。
    结果:19例患者手术顺利，其中腹腔镜辅助远端胃癌根治+直肠前切除术3例；腹腔镜辅助远端胃癌根治+胰十二指肠切除术1例；腹腔镜辅助右半结肠切除+胃体胃肠道间质瘤楔形切除术1例；腹腔镜辅助右半结肠切除+直肠前切除术4例；腹腔镜辅助左半结肠切除+直肠前切除术4例；腹腔镜辅助乙状结肠切除+直肠切除术6例。平均手术时间为228 min(145～380 min)，辅助切口平均长度为5 cm(4～7 cm)，术中平均出血量为86 mL(10～250 mL)，无中转开腹患者。平均清扫淋巴结数目为39枚(21～58枚)，平均阳性淋巴结数目为3枚(0～6枚)。术后拔除腹腔引流管平均时间为3 d(2～6 d)，术后恢复进食平均时间为4 d(2～7 d)，术后平均住院时间为10 d(7～21 d)。术后并发切口感染1例，经对症处理后痊愈出院。患者术后平均随访时间为24个月(3～48个月)，1例失访，12例无瘤生存，4例带瘤生存，2例因肿瘤相关原因死亡。
    结论:腹腔镜手术治疗同时性胃肠道多原发癌是安全、可行的，且具有创伤小、恢复快的优点。

     

    Abstract: Objective:To investigate the safety and feasibility of laparoscopic resection for synchronous gastrointestinal multiple primary cancers.
    Methods:The clinical data of 19 patients with synchronous gastrointes tinal multiple primary cancers who received laparoscopic resection at the Third Affiliated Hospital of Sun Yat Sen University from January 2009 to January 2014 were retrospectively analyzed. Patients were followed up via in and out patient examination, phone call or mail till April 2014 or death of the patients.
    Results:The operation was successfully carried out on all the patients. Three patients received laparoscopic assisted distal gastrectomy+anterior resection of rectum; 1 received laparoscopic distal gastrectomy+pancreaticoduodenectomy; 1 received laparoscopic assisted right hemicolectomy+gastric body wedge resection; 4 received laparoscopic assisted right hemicolectomy+anterior resection of rectum; 4 received laparoscopic assisted left hemicolectomy+anterior resection of rectum; 6 received laparoscopic assisted proctosigmoidectomy. The mean operation time, length of assisted incision, volume of blood loss were 228 minutes (range, 145 -380 minutes), 5 cm (range, 4 -7 cm) and 86 mL (range, 10 -250 mL), respectively. No patients were converted to open surgery. The mean number of lymph nodes dissected was 39 (range, 21 -58), and 3 lymph nodes (range, 0 -6) were positive. The time of drainage tube removal, time to food intake and duration of postoperative hospital stay were 3 days (range, 2 -6 days), 4 days (range, 2 -7 days) and 10 days (range, 7 -21 days), respectively. One patient was complicated with incisional infection and was cured by symptomatic treatment. The mean time of follow up was 24 months (range, 3 48 months) . One patient missed the follow up, 12 survived without tumor, 4 were alive with tumor, and 2 died due to tumor related factors.
    Conclusion:Laparoscopic resection for the treatment of synchronous gastrointestinal multiple primary cancer is safe and feasible, with advantages of little trauma and fast recovery.

     

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