Li G X, Li J M, Wang Y N, Deng H J, Mou T Y, Liu H
Department of General Surgery, Nanfang Hospital, Southern Medical University, Guangzhou 510515, China.
Zhonghua Wai Ke Za Zhi. 2017 Jul 1;55(7):515-520. doi: 10.3760/cma.j.issn.0529-5815.2017.07.008.
To evaluate the short-term and oncologic outcomes of single-incision plus one port laparoscopic surgery (SILS+ 1) for sigmoid colon and upper rectal cancer. The clinic data of 46 patients with sigmoid colon and upper rectal cancer underwent SILS+ 1 at Department of General Surgery, Nanfang Hospital, Southern Medical University from September 2013 to September 2014 were retrospectively reviewed (SILS+ 1 group). After generating 1∶1 ration propensity scores given the covariates of age, gender, body mass index, American Society of Anesthesiologists score, surgeons, tumor location, the distance of tumor from anal, tumor diameter, and pathologic TNM stage, 46 patients with sigmoid colon and upper rectal cancer underwent conventional laparoscopic surgery (CLS) in the same time were matched as CLS group. The baseline characteristics and short-term outcomes were compared using test, χ(2) test or Wilcoxon signed ranks test. Kaplan-Meier survival curves and Log-rank tests demonstrated the distribution of disease free survival. The two study groups were well balanced with respect to the baseline characteristics of the propensity score derivation model. As compared to the CLS group, patients in SILS+ 1 group had a smaller incision ((6.9±1.1) cm . (8.4±1.2) cm, =6.502, =0.000), less estimated blood loss (20(11) ml . 50(30) ml, =2.414, =0.016), shorter intracorporeal operating time ((67.0±25.8) minutes . (75.5±27.7) minutes, =2.062, =0.042) and significantly faster recovery course including shorter time to first ambulation ((46.7±20.3) hours . (78.6±28.0) hours, =6.255, =0.000), shorter time to first oral diet ((64.7±28.8) hours . (77.1±30.0) hours, =2.026, =0.047), shorter time of postoperative hospital stay ((7.8±2.2) days . (6.5±2.2) days, =2.680, =0.009), and lower postoperative visual analogue scale scores (=4.721, =0.032). No significant difference was observed in total operating time, postoperative morbidity, first time to flatus and defecation, analgesic use, number of retrieved lymph nodes and resection margin. During the median follow-up period of 33 months (ranging from 7 to 39 months) , there was no significant difference between the two groups in terms of 3-year disease-free survival (SILS+ 1: 91.3%, CLS: 93.4%, =1.000). The recurrence rates of SILS+ 1 group and CLS groups were 8.7% (4/46) and 6.5% (3/46), respectively. For experienced CLS surgeons, the SILS+ 1 for sigmoid colon and upper rectal cancer would be easiness, safe and efficient alternative.
评估单孔加单辅助腹腔镜手术（SILS+1）治疗乙状结肠癌和上段直肠癌的短期及肿瘤学结局。回顾性分析2013年9月至2014年9月在南方医科大学南方医院普通外科接受SILS+1手术的46例乙状结肠癌和上段直肠癌患者的临床资料（SILS+1组）。根据年龄、性别、体重指数、美国麻醉医师协会评分、手术医生、肿瘤位置、肿瘤距肛门距离、肿瘤直径和病理TNM分期等协变量生成1∶1倾向得分后，选取同期46例接受传统腹腔镜手术（CLS）的乙状结肠癌和上段直肠癌患者作为CLS组。采用t检验、χ²检验或Wilcoxon符号秩和检验比较两组的基线特征和短期结局。Kaplan-Meier生存曲线和Log-rank检验显示无病生存分布情况。两个研究组在倾向得分推导模型的基线特征方面具有良好的平衡性。与CLS组相比，SILS+1组患者的切口更小（（6.9±1.1）cm比（8.4±1.2）cm，t=6.502，P=0.000）、估计失血量更少（20（11）ml比50（30）ml，t=2.414，P=0.016）、体内手术时间更短（（67.0±25.8）分钟比（75.5±27.7）分钟，t=2.062，P=0.042），恢复过程明显更快，包括首次下床活动时间更短（（46.7±20.3）小时比（78.6±28.0）小时，t=6.255，P=0.000）、首次经口进食时间更短（（64.7±28.8）小时比（77.1±30.0）小时，t=2.026，P=0.047）、术后住院时间更短（（7.8±2.2）天比（6.5±2.2）天，t=2.680，P=0.009）以及术后视觉模拟评分更低（t=4.721，P=0.032）。两组在总手术时间、术后并发症、首次排气和排便时间、镇痛药物使用、获取淋巴结数量和切缘方面未观察到显著差异。在中位随访期33个月（7至39个月）内，两组的3年无病生存率无显著差异（SILS+1组：91.3%，CLS组：93.4%，P=1.000）。SILS+1组和CLS组的复发率分别为8.7%（4/46）和6.5%（3/46）。对于有经验的CLS手术医生而言，SILS+1手术治疗乙状结肠癌和上段直肠癌简便、安全且有效。
