腹腔鏡輔助結(jié)直腸手術(shù)

1、腹腔鏡輔助結(jié)直腸手術(shù)的歷史,首例腹腔鏡輔助結(jié)腸腸手術(shù)于1991年Redine DB完成首例腹腔鏡輔助結(jié)腸腸癌手術(shù)1991年由Jacobs M完成香港、臺(tái)灣、韓國(guó)、日本、歐美等國(guó)家開(kāi)展比較普及國(guó)內(nèi)京津環(huán)渤海、珠三角、長(zhǎng)三角、成渝較普及,腹腔鏡結(jié)直腸癌手術(shù)種類(lèi),完全腹腔鏡手術(shù)腹腔鏡輔助手術(shù)手助腹腔鏡手術(shù),laparoscopic resection of rectosigmoid carcinoma:prospective ra

2、ndomised trial,Leung KL, et al. Lancet;2004,363,(9416),1187~1192,,,,,,,北美外科治療臨床療效研究組（COST）,腹腔鏡組428例 開(kāi)腹組435例中轉(zhuǎn)開(kāi)腹21%（90/435）手術(shù)時(shí)間150min對(duì)90min術(shù)后恢復(fù)腹腔鏡組更快住院時(shí)間更短3d對(duì)4d手術(shù)期間并發(fā)癥術(shù)后30日內(nèi)死亡率術(shù)后60天內(nèi)并發(fā)癥再入院率在

3、手術(shù)率,,差異無(wú)顯著性,n engl j med 350;20 13, 2004,切口長(zhǎng)度,手術(shù)時(shí)間,口服鎮(zhèn)痛藥,弱安定藥,住院日,,并發(fā)癥,,,,,根治性,Cost,,,Cost研究腫瘤復(fù)發(fā)轉(zhuǎn)移比較,腹腔鏡組16%,開(kāi)腹組18%,Cost研究3年生存率比較,腹腔鏡組86%,開(kāi)腹組85%,Cost研究長(zhǎng)期隨訪結(jié)果,Patients were followed for 8 years, with 5-year data on 90

4、% of patients. median of 7 years (range 5-10 years) .Disease-free 5-year survival (Open 68.4%, Laparoscopic 69.2%, P=0.94) Overall 5-year survival (Open 74.6%, Laparoscopic 76.4%, P=0.93) Overall recurrence rates were

5、 similar for the 2 groups (Open 21.8%, Laparoscopic 19.4%, P=0.25) These recurrences were distributed similarly between the 2 treatment groups (Open: wound 0.5%, liver 5.8%, lung 4.6%, other 8.4%; Laparoscopic: wound 0.

6、9%, liver 5.5%, lung 4.6%, other 6.1%). CONCLUSION: Laparoscopic colectomy for curable colon cancer is not inferior to open surgery based on long-term oncologic endpoints from a prospective randomized trial.,Ann Surg.

7、2007 Oct;246(4):655-62; discussion 662-4,Long-term outcome of laparoscopic surgery for colorectal cancer:A cochrane systematic review of randomised controlled trials.,Results: Twelve trials (3346 patients) reported long

8、-term outcome 腹腔鏡和開(kāi)放結(jié)直腸癌切除在切口疝和因腸粘連再手術(shù)方面無(wú)顯著性差異 (p = 0.32 and 0.30, respectively)Trocar和切口部位轉(zhuǎn)移上無(wú)顯著性差異(p = 0.16).癌有關(guān)的死亡率在最大隨訪期內(nèi)相似 (p = 0.15 and 0.16 for colon and rectal cancer, respectively)腹腔鏡與開(kāi)放結(jié)腸癌切除術(shù)后癌復(fù)發(fā)轉(zhuǎn)移無(wú)顯著性差

9、異在隨訪期內(nèi)腹腔鏡與開(kāi)放手術(shù)術(shù)后死亡率無(wú)顯著性差異Conclusions: Laparoscopic resection of carcinoma of the colon is associated with a long-term outcome that is similar to that after open colectomy. Laparoscopic surgery for cancer of the upper

10、 rectum is feasible, but more randomised trials need to be conducted to assess long-term outcome.,Cancer Treat Rev (2008), doi:10.1016/j.ctrv.2008.03.011,腹腔鏡結(jié)直腸癌手術(shù)進(jìn)展,手術(shù)根治性與開(kāi)腹手術(shù)相同標(biāo)本長(zhǎng)度、切緣陽(yáng)性率及淋巴結(jié)檢出數(shù)量等;手術(shù)安全性好術(shù)中并發(fā)癥、術(shù)后總體并發(fā)癥