腹腔镜辅助结直肠手术.ppt

腹腔镜辅助结直肠手术的历史,首例腹腔镜辅助结肠肠手术于1991年Redine DB完成 首例腹腔镜辅助结肠肠癌手术1991年由Jacobs M完成 香港、台湾、韩国、日本、欧美等国家开展比较普及 国内京津环渤海、珠三角、长三角、成渝较普及,腹腔镜结直肠癌手术种类,完全腹腔镜手术 腹腔镜辅助手术 手助腹腔镜手术,laparoscopic resection of rectosigmoid carcinoma: prospective randomised trial,Leung KL, et al. Lancet;2004,363,(9416),11871192,北美外科治疗临床疗效研究组（COST）,腹腔镜组428例 开腹组435例 中转开腹21%（90/435） 手术时间150min对90min 术后恢复腹腔镜组更快 住院时间更短3d对4d 手术期间并发症 术后30日内死亡率 术后60天内并发症 再入院率 在手术率,差异无显著性,n engl j med 350;20 13, 2004,切口长度,手术时间,口服镇痛药,弱安定药,住院日,并发症,根治性,Cost,Cost研究肿瘤复发转移比较,腹腔镜组 16%,开腹组 18%,Cost研究3年生存率比较,腹腔镜组 86%,开腹组 85%,Cost研究长期随访结果,Patients were followed for 8 years, with 5-year data on 90% 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 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 0.9%, 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. 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-term outcome 腹腔镜和开放结直肠癌切除在切口疝和因肠粘连再手术方面无显著性差异 (p = 0.32 and 0.30, respectively) Trocar和切口部位转移上无显著性差异(p = 0.16). 癌有关的死亡率在最大随访期内相似 (p = 0.15 and 0.16 for colon and rectal cancer, respectively) 腹腔镜与开放结肠癌切除术后癌复发转移无显著性差异 在随访期内腹腔镜与开放手术术后死亡率无显著性差异 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 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,腹腔镜结直肠癌手术进展,手术根治性与开腹手术相同 标本长度、切缘阳性率及淋巴结检出数量等; 手术安全性好 术中并发症、术后总体并发症和具体并发症; 术后恢复快 腹腔镜手术术后疼痛更轻，排气时间、肠蠕动恢复时间、饮食恢复时间及出院时间均早于开腹手术组病人。 肿瘤治疗的远期效果不次于开腹