单孔腹腔镜右半结肠切除术与传统腹腔镜治疗恶性肿瘤的比较：评估围手术期和短期肿瘤学结果。
Single-incision laparoscopic right colectomy compared with conventional laparoscopy for malignancy: assessment of perioperative and short-term oncologic outcomes.
机构信息
Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, 50, Irwon-dong, Gangnam-gu, 135-710, Seoul, Korea.
出版信息
Surg Endosc. 2013 Jun;27(6):2122-30. doi: 10.1007/s00464-012-2722-5. Epub 2013 Jan 15.
BACKGROUND
Laparoscopic colectomy for malignancy currently is the standard operative technique together with open colectomy. Single-incision laparoscopic surgery (SIL) is a recent advance in minimally invasive surgical techniques. This study aimed to compare SIL right colectomy with conventional laparoscopy (CL) used to treat patients with colon cancer.
METHODS
This study was a retrospective analysis of data from the authors' prospectively collected colorectal surgery database. Between August 2009 and November 2010, 159 patients who underwent primary laparoscopic right colectomy at the Samsung Medical Center were recruited to participate in this study. Of these, 66 patients underwent SIL colectomy.
RESULTS
The SIL and CL right colectomy groups did not differ significantly in terms of general characteristics including age, sex, body mass index (BMI), American society of anesthesiology (ASA) score, previous abdominal operation, and diagnosis. The two groups also did not differ significantly in terms of perioperative complications (9.1 vs. 15.1 %, p = 0.335). Oncologic resection was similar in the two groups. The mean number of harvested lymph nodes was 24 for SIL and 27 for CL right colectomy (p = 0.068). Tumor size, disease stage, adjuvant chemotherapy, and proximal and distal resection margins did not differ significantly between the two groups. The mean follow-up period was 24.5 for the SIL group and 26.4 months for the CL group (p = 0.098), with six recurrences in the SIL group (9.1 %) and three recurrences in the CL group (3.2 %) (p = 0.120). One death occurred in the CL group. Disease-free survival at 24 months did not differ significantly between the two groups (89.7 vs. 96.3 %, p = 0.120).
CONCLUSION
The findings show that SIL right colectomy for colon cancer is safe and can provide resection and oncologic outcomes equal to those of conventional laparoscopic right colectomy.
背景
腹腔镜结直肠切除术目前是标准的手术方法，与开腹结直肠切除术相结合。单切口腹腔镜手术（SIL）是微创外科技术的最新进展。本研究旨在比较 SIL 右半结肠切除术与传统腹腔镜（CL）治疗结肠癌的效果。
方法
这是一项对作者前瞻性收集的结直肠手术数据库数据的回顾性分析。2009 年 8 月至 2010 年 11 月，在三星医疗中心接受原发性腹腔镜右半结肠切除术的 159 例患者被招募入组。其中，66 例患者接受 SIL 结肠切除术。
结果
SIL 和 CL 右半结肠切除术组在年龄、性别、体重指数（BMI）、美国麻醉医师协会（ASA）评分、既往腹部手术和诊断等一般特征方面无显著差异。两组围手术期并发症（9.1% vs. 15.1%，p=0.335）也无显著差异。两组的肿瘤根治性切除相似。SIL 组和 CL 组的平均淋巴结检出数分别为 24 枚和 27 枚（p=0.068）。肿瘤大小、疾病分期、辅助化疗、近端和远端切缘在两组间无显著差异。SIL 组的平均随访时间为 24.5 个月，CL 组为 26.4 个月（p=0.098），SIL 组有 6 例（9.1%）复发，CL 组有 3 例（3.2%）复发（p=0.120）。CL 组有 1 例死亡。两组 24 个月无病生存率无显著差异（89.7% vs. 96.3%，p=0.120）。
结论
结果表明，SIL 右半结肠癌切除术安全可行，能提供与传统腹腔镜右半结肠切除术相当的切除和肿瘤学效果。
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