Leung K L, Yiu R Y, Lai P B, Lee J F, Thung K H, Lau W Y
Department of Surgery, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, New Territories.
Dis Colon Rectum. 1999 Mar;42(3):327-32; discussion 332-3. doi: 10.1007/BF02236347.
The place of laparoscopic-assisted colectomy for colorectal carcinoma is controversial. This study reviewed a consecutive series of patients who underwent laparoscopic-assisted resection of colorectal carcinoma in the past five years.
Two hundred seventeen laparoscopic-assisted resections of colorectal carcinoma were attempted starting in April 1992. Initially, we only selected patients with metastatic disease or patients who were older than 65 years. Subsequently, both palliative and curative resections were attempted in patients with a suitable tumor, with no age limitation. Thus, all suitable patients were randomly assigned to received either laparoscopic-assisted or conventional open surgery.
Data collection was completed in 201 patients. In 22 patients open surgery was performed after a diagnostic laparoscopy. In the remaining 179 patients (90 males) in whom laparoscopic dissection was actually performed, the mean follow-up was 19.8 months, and the mean age was 66.3 years. The procedures performed included right hemicolectomy or extended right hemicolectomy (30 patients), transverse colectomy (2 patients), left hemicolectomy (3 patients), sigmoidectomy (48 patients), anterior resection (59 patients), and abdominoperineal resection (37 patients). Thirty-two (17.7 percent) procedures were converted to open surgery. The mean operation time was 203 minutes. The median blood loss was negligible, and the median requirement of transfusion was zero. The median number of postoperative parenteral analgesic injections was three. The median time to resume diet and hospital discharge were four and six days, respectively. The operative mortality was 1.7 percent. The survival rates at four years were 100, 88.3, and 64.5 percent for patients with Dukes A, B, and C disease, respectively. There was only one (0.65 percent) port-site recurrence.
Laparoscopic-assisted resection of colorectal carcinoma was technically feasible and safe. It allowed early postoperative recovery with satisfactory long-term survival. This is at the expense of a long operation. Its benefits over the conventional open technique await the results of the randomized trials.
腹腔镜辅助结肠切除术在结直肠癌治疗中的地位存在争议。本研究回顾了过去五年中连续接受腹腔镜辅助结直肠癌切除术的一系列患者。
自1992年4月起共尝试进行217例腹腔镜辅助结直肠癌切除术。最初，我们仅选择有转移性疾病的患者或年龄大于65岁的患者。随后，对合适的肿瘤患者进行姑息性和根治性切除术，无年龄限制。因此，所有合适的患者被随机分配接受腹腔镜辅助手术或传统开放手术。
201例患者完成数据收集。22例患者在诊断性腹腔镜检查后进行了开放手术。在实际进行腹腔镜解剖的其余179例患者（90例男性）中，平均随访时间为19.8个月，平均年龄为66.3岁。所进行的手术包括右半结肠切除术或扩大右半结肠切除术（30例患者）、横结肠切除术（2例患者）、左半结肠切除术（3例患者）、乙状结肠切除术（48例患者）、前切除术（59例患者）和腹会阴联合切除术（37例患者）。32例（17.7%）手术转为开放手术。平均手术时间为203分钟。术中失血中位数可忽略不计，输血中位数需求为零。术后胃肠外镇痛注射次数中位数为3次。恢复饮食和出院的中位时间分别为4天和6天。手术死亡率为1.7%。Dukes A、B和C期疾病患者的四年生存率分别为100%、88.3%和64.5%。仅发生1例（0.65%）切口部位复发。
腹腔镜辅助结直肠癌切除术在技术上可行且安全。它使患者术后能早期恢复，并具有令人满意的长期生存率。代价是手术时间长。其相对于传统开放技术的优势有待随机试验的结果。
