Laparoscopic Low Anterior Resection for Selected Mid and Low Rectal Cancers

目的　這篇研究的目的是為了去證實在可完全且完整切除低位直腸癌，使用腹腔鏡手術的適應症，及評估它的安全性、益處及預後。方法　我們使用了前瞻性的方法，選擇了41位病人接受治癒性的腹腔鏡前低位切除手術，排除的標準包括了急診手術、巨大的腫瘤、遠處轉移、及曾經接受過腹部手術的病人，我們收集的數據包括病人的年齡、性別、身體質量指數、美國麻醉科醫學會的危險指數、接口吻和方式及病人的預後。結果　自1999年12月到2002年12月，41位接受腹腔鏡前低位切除並結腸肛門口吻合手術的病人，其中包含14位男性(31.7%)與二十八位女性(68.3%)，平均年齡為63.2歲（從41到79歲），在這41位病人中沒有因手術而死亡的，平均血液流失為187.7毫升（50-1000毫升），平均手術時間為236.9分鐘（145至305分鐘），平均術後開始進食的時間為手術後第3天（2天至6天），平均住院天數為8.9天（4天至41天），其中有5位病人(10.2%)改為傳統開腹手術方式，而有6位病人(14.6%)在術後產生併發症，術後的病理分期包含了19位第一期，7位第二期，14位第三期，而其中1位病人在接受術前合併化學併放射治療後，發現沒有殘存的腫瘤，全部病人的3年存活率為80.5%，但是其中3位病人發現有遠處轉移的情形，2位有局部復發，其中1位在腹腔鏡的切口處復發。結論　藉由我們的研究，我們知道只要好好的選擇病人，腹腔鏡的前低位切除手術，不僅不會使手術的併發症增加，更重要的是在病人的預後方面與傳統的前低位切除手術亦沒有差別，但要評估腹腔鏡手術是否優於傳統的開腹手術，仍需要大型的隨機，前瞻性的研究來證實。

關鍵字

手術前化學放射治療；腹腔鏡；全直腸繫膜切除；直腸癌

並列摘要

Purpose. Study aim was to evaluate safety, efficacy, and outcome for laparoscopic curative resection of middle and low rectal cancer. Methods. Forty-one patients were prospectively selected. Exclusion criteria were emergency surgery, bulky tumor, distant metastases,, and previous extensive abdominal surgery. Data were collected for age, gender, body mass index, American Society of Anesthesiologists' physical status, diagnosis, method of anastomosis, and outcome. Results. Between December 1999 and December 2002, 41 patients (13 men, 28 women; mean age, 63.2 years; range, 41-79) with middle and low rectal cancer underwent laparoscopic total mesorectal excision with coloanal anastomosis. There was no mortality. Perioperative data showed an estimated blood loss of 187.7 cc (50-1000), average operating time of 236.9 minutes (145-305), resumption of oral diet at postoperative day 3 (2-6), and length of stay 8.9 days (4-41). Five (12.2%) patients were converted to open surgery, and six (l4.6%) patients developed postoperative complications. Postoperative staging was 19 stage Ⅰ, 7 stage Ⅱ, and 14 stage Ⅲ cases; the remaining patient, who had preoperative concurrent chemoradiotherapy, had no residual tumor. The overall survival rate was 80.5% at a mean follow-up of 4l.3 months. Three patients developed distant metastases, and two developed local recurrence. Conclusions. Although there is bias in this study, it demonstrates laparoscopic total mesorectal excision can be performed for selected patients without adding surgical morbidity. Most importantly, our experience shows that laparoscopy with an experienced surgeon does not alter outcome. A prospective randomized trial with long-term follow-up is needed to fully assess laparoscopic excision versus open surgery.

並列關鍵字

CCRT ； Laparoscope ； Rectal cancer ； TME

國際替代計量

Laparoscopic Low Anterior Resection for Selected Mid and Low Rectal Cancers

全文下載

主題瀏覽