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肥胖患者腹腔镜结直肠癌切除术的手术结果:与开腹结直肠癌切除术的对比研究

Surgical outcome of laparoscopic colectomy for colorectal cancer in obese patients: A comparative study with open colectomy.

作者信息

Cai Yantao, Zhou Yiming, Li Zhenyang, Xiang Jianbin, Chen Zongyou

机构信息

Department of General Surgery, Huashan Hospital Affiliated to Fudan University, Shanghai 200040, P.R. China.

出版信息

Oncol Lett. 2013 Oct;6(4):1057-1062. doi: 10.3892/ol.2013.1508. Epub 2013 Aug 2.

Abstract

The aim of the present study was to assess the short-term outcome and survival time of 166 obese patients who received laparoscopic and open colectomy for colorectal cancer (CRC) between January 2007 and December 2012. All 166 patients included in the study had a BMI >28. Laparoscopic or open colectomy procedures were performed on 64 and 102 patients, respectively. The short-term outcome and post-operative survival rates were compared. The patient characteristics were similar between the two groups. Laparoscopic colectomy correlated with an increased duration of surgery compared with open colectomy (183 vs. 167 min, respectively; P<0.05) but intraoperative blood loss was decreased (168 vs. 188 ml, respectively; P<0.05). Hospitalization costs were slightly higher following the laparoscopic procedure compared with open surgery, but this was affordable for the majority of patients (¥56,484 vs. ¥56,161, respectively; P<0.05). The incidence of wound infection (17 vs. 31%; P<0.05) and abdominal abscess rates (6 vs. 18%; P<0.05) were reduced in the laparoscopic group compared with the open group. Pathological characteristics were identified to be similar and no significant differences were identified in overall (log-rank test; P=0.85) and disease-free (log-rank test; P=0.85) survival between the two types of surgery (log-rank test; P=0.76). The current retrospective study demonstrated an improved short-term outcome in laparoscopic colectomy for CRC patients with a BMI >28 compared with patients who underwent the open procedure. Laparoscopic colectomy is technically and oncologically safe and must be popularized in obese CRC patients.

摘要

本研究的目的是评估2007年1月至2012年12月期间166例因结直肠癌(CRC)接受腹腔镜和开放结肠切除术的肥胖患者的短期结局和生存时间。纳入研究的所有166例患者的体重指数(BMI)均>28。分别对64例和102例患者进行了腹腔镜或开放结肠切除术。比较了短期结局和术后生存率。两组患者的特征相似。与开放结肠切除术相比,腹腔镜结肠切除术的手术时间延长(分别为183分钟和167分钟;P<0.05),但术中失血量减少(分别为168毫升和188毫升;P<0.05)。与开放手术相比,腹腔镜手术后的住院费用略高,但大多数患者都能承受(分别为56,484元和56,161元;P<0.05)。与开放组相比,腹腔镜组的伤口感染发生率(17%对31%;P<0.05)和腹腔脓肿发生率(6%对18%;P<0.05)降低。病理特征相似,两种手术方式在总生存(对数秩检验;P=0.85)和无病生存(对数秩检验;P=0.85)方面均未发现显著差异(对数秩检验;P=0.76)。目前的回顾性研究表明,与接受开放手术的患者相比,BMI>28的CRC患者行腹腔镜结肠切除术的短期结局有所改善。腹腔镜结肠切除术在技术和肿瘤学上是安全的,必须在肥胖的CRC患者中推广。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/83bf/3796378/5750814ad292/OL-06-04-1057-g00.jpg

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