【摘要】 目的探讨腹腔镜下结直肠癌切除术联合肝转移瘤射频消融术治疗结直肠癌肝转移(colorectal cancer liver metastases,CRLM)患者的临床疗效。方法选取2016年5月至2017年3月于普宁市人民医院诊治的105例CRLM患者,按随机数字表法分为对照组(50例)和观察组(55例),对照组行腹腔镜结直肠癌切除术联合肝转移灶切除术,观察组行腹腔镜下结直肠癌切除术联合肝转移瘤射频消融术,采用独立样本t检验比较两组患者相关手术指标(手术时间、术后肛门首次排气、住院时间等),采用χ~2检验比较术后并发症(吻合口狭窄、吻合口出血、切口感染等)、术后复发率及生存率。结果观察组患者手术时间[(254.57±33.41)min vs(290.52±36.42)min;t=5.276,P <0.001]、术中出血量[(187.16±89.52)ml vs(383.63±88.34)ml;t=11.302,P <0.001]、术后肛门首次排气时间[(2.48±0.36)d vs(3.50±0.25)d;t=16.702,P <0.001]、住院时间[(13.25±4.60)d vs(18.73±4.10)d;t=6.419,P <0.001]、治疗费用[(37072±505)元vs(41059±504)元;t=40.442,P <0.001]及术后VAS评分[(4.02±0.26)分vs(7.25±0.63)分;t=34.906,P <0.001]均显著低于对照组。观察组和对照组患者观察组和对照组患者术后切口感染(1.82%vs 12.00%)、吻合口狭窄(1.82%vs 4.00%)、吻合口出血(1.82%vs 4.00%)、输尿管损伤(1.82%vs 4.00%)、吻合口瘘(0%vs 2.00%)、粘连性肠梗阻(1.82%vs 12.00%)、排尿困难(0%vs 2.00%)等并发症发生率差异无统计学意义(P均> 0.05)。观察组和对照组患者术后3年局部复发率分别为12.73%(7/55)、20.00%(10/50),差异无统计学意义(χ~2=1.021,P=0.312)。观察组患者术后1年、2年和3年的生存率分别为90.91%(50/55)、85.45%(47/55)、81.82%(45/55),对照组分别为90.00%(45/50)、86.00%(43/50)、84.00%(42/50),差异均无统计学意义(χ~2值分别为0.025、0.006、0.088,P值分别为0.874、0.936、0.767)。观察组患者术后1年、2年和3年的无瘤生存率分别为76.36%(42/55)、72.73%(40/55)、45.45%(25/55),对照组分别为76.00%(38/50)、60.00%(30/50)、40.00%(20/50),差异均无统计学意义(χ~2值分别为0.002、0.062、0.318,P值分别为0.965、0.804、0.573)。结论腹腔镜下结直肠癌切除术联合肝转移瘤射频消融术可显著减少CRLM患者术中出血量,加快术后康复时间,减少术后并发症,近期疗效和安全性良好。更多还原

【Abstract】 Objective To investigate the clinical efficacy of laparoscopic colorectal cancer resection combined with liver metastases radiofrequency ablation in treatment of patients with colorectal cancer liver metastases(CRLM). Methods A total of 105 patients with CRLM who were treated in Puning People’s Hospital from May 2016 to March 2017 were selected and divided into control group(50 cases) and observation group(55 cases) according to the random digital table method. Patients in control group were given laparoscopic colorectal cancer resection combined with liver metastases resection, and patients in observation group were given laparoscopic colorectal cancer resection combined with liver metastases radiofrequency ablation. The operation parameters(operation time, first anal exhaust time after operation, hospital stay, etc) of patients in both groups were compared by independent-sample t test, postoperation complications(anastomotic stenosis, anastomotic bleeding, incision infection, etc.), recurrence rate and survival rate of patients in both groups were compared by χ~2 test. Results The operation time [(254.57 ± 33.41) min vs(290.52 ± 36.42) min; t = 5.276, P < 0.001], interoperative bleeding volume [(187.16 ± 89.52) ml vs(383.63 ± 88.34) ml; t = 11.302, P < 0.001], first anal exhaust time after operation [(2.48 ± 0.36) d vs(3.50 ± 0.25) d; t = 16.702, P < 0.001], hospitalization time [(13.25 ± 4.60) d vs(18.73 ± 4.10) d; t = 6.419, P < 0.001], treatment cost [(37072 ± 505) yuan vs(41059.46 ± 504.73) yuan; t = 40.442, P < 0.001] and VAS score [(4.02 ± 0.26) points vs(7.25 ± 0.63) points; t = 34.906, P < 0.001] of patients in observation group were significantly lower than those of control group. The incidence of complications including incisional wound infection(1.82% vs 12.00%), anastomotic stenosis(1.82% vs 4.00%), anastomotic bleeding(1.82% vs 4.00%), ureteral injury(1.82% vs 4.00%), anastomotic fistula(0% vs 2.00%), adhesive ileus(1.82% vs 12.00%) and dysuria(0% vs 2.00%) of patients in observation group and control group were not statistically significant(all P > 0.05). The local recurrence rate within 3 years of patients in observation and control group were 12.73%(7/55) and 20.00%(10/50), respectively, the difference was not statistically significant(χ~2 = 1.021, P = 0.312). The survival rates of 1 year, 2 years and 3 years after surgery of patients in observation group were 90.91%(50/55), 85.45%(47/55) and 81.82%(45/55), respectively, which were 90.00%(45/50), 86.00%(43/50) and 84.00%(42/50) in observation group, respectively, the differences were not statistically significant(χ~2 = 0.025, 0.006, 0.088; P = 0.874, 0.936, 0.767). The tumor-free survival rates within 1 year, 2 years and 3 years after surgery of patients in observation group were 76.36%(42/55), 72.73%(40/55) and 45.45%(25/55), respectively, which were 76.00%(38/50), 60.00%(30/50) and 40.00%(20/50) in observation group, respectively, the differences were not statistically significant(χ~2 = 0.002, 0.062, 0.318; P = 0.965, 0.804, 0.573). Conclusions Laparoscopic colorectal cancer resection combined with liver metastases radiofrequency ablation in treatment of patients with CRLM can significantly reduce the amount of bleeding, speed up the recovery time, reduce postoperative complications, with good short-term efficacy and safety.更多还原