Laparoscopic Assisted Right Hemicolectomy-10 Years Experience in Chung-Hua Christian Hospital

腹腔鏡輔助右側大腸切除術─彰化基督教醫院10年經驗

陳成賢(Cheng-Hsien Chen) ； 陳宏彰(Hong-Chang Chen) ； 尤昭傑(Jau-Jie You) ； 林倉祺(Tsang-Chi Lin) ； 黃玄遠(Hsuan-Yuan Huang) ； 黃燈明(Ting-Ming Huang)

《中華民國大腸直腸外科醫學會雜誌》 23卷1期 (2012/03) Pp. 19-26

https://doi.org/10.6312/SCRSTW.2012.23(1).10006

摘要

目的　腹腔鏡手術已是近年來的潮流，我們在此次研究中分析本院10年間腹腔鏡輔助右側大腸切除術的成果。方法　本研究是採取回溯性分析。分析本院自1999年1月至2008年12月間接受腹腔鏡輔助右側大腸切除術的患者，共89位。同時間內比較85名接受傳統右側大腸切除術的患者做對照組。結果　接受腹腔鏡手術的患者，手術時間明顯比傳統手術為長（208 min vs.162 min, p=0.036），但是出血量是明顯較少（93 ml vs. 210 ml, p=0.06）。在淋巴結廓清上，兩者並無顯著差異（24 vs. 22, p=0.427）。接受腹腔鏡手術的組別在術後有明顯較短的首次恢復腸蠕動的時間（2.41 days vs. 2.76 days, p=0.027）及由口進食的時間（1.66 days vs. 2.08 days, p=0.019）。此外，接受腹腔鏡手術的患者有較短的住院天數（7.33 days vs. 11.44 days, p=0.131）及低併發症發生率（.2% vs. 17.6%, p=0.068）。轉換術式的比例為4.5%（4／89）。比較兩組的五年存活率，兩種術式是相似的（67.9% vs. Open：67.9%, p=0.531）。以各期別來看，結果亦然。第一期：87.5% vs. 80.2%（p=0.529）。第二期：73.5% vs. 67.5%（p=0.404）。第三期：57.9% vs. 61.7%（p=0.663）。比較兩組的五年無病存活率，兩種術式是相似的（68.3% vs. Open：65.8%, p=0.405）。以各期別來看，結果亦然。第一期：71.4% vs. 80.2%（p=0.502）。第二期：74.5% vs. 65.2%（p=0.272）。第三期：55.6%vs.58.4%（p=0.610）。接受腹腔鏡手術的組別，局部復發率為1.18%，而傳統手術組則為3.53%。結論　根據我們的經驗，腹腔鏡輔助右側大腸切除術是個安全而且適當的手術。

關鍵字

腹腔鏡手術 ； 右側大腸切除術 ； 大腸癌

並列摘要

Purpose. Laparoscopic surgery has became the current trend for colorectal cancer. Thus Chang-Hua Christian Hospital has gathered and analyzed data based on ten years of experience in laparoscopic assisted right hemicolectomy. Materials and Methods. This study retrospectively analyzed 89 patients who underwent laparoscopic assisted right hemicolectomy for colon cancer at Chang-Hua Christian Hospital between January 1999 to December 2008. During the same time period, 85 additional patients who underwent open right hemicolectomy were compared. Results. Patients who underwent laparoscopic resections require significantly longer operation time compared to the open methods (208 min vs. 162 min, p = 0.036) but suffered less blood loss (93 ml vs. 210 ml, p = 0.06). There were no significant differences in the number of lymph nodes harvested for cancer resections (Scopy: 24 vs. Open: 22). Comparing post-operative recovery time, the laparoscopic group had a shorter delay for first time post-operative bowel movement (2.41 days vs. 2.76 days, p = 0.027) and oral intake (1.66 days vs. 2.08 days, p = 0.019). Furthermore, the laparoscopic group spent fewer days in the hospital (7.33 days vs. 11.44 days, p = 0.131) and in addition had a lower complication rate compared with the open group (8.2% vs. 17.6%, p = 0.068). The convertion rate was 4.5% (4/89). Comparing the 5-year survival rate for all stages, both groups have a similar survival rate (Scopy: 67.9% vs. Open: 67.9%, p = 0.531). In stage I patients, there were no significant differences between both groups (Scopy: 87.5% vs. Open: 80.2%, p = 0.529). In stage II patients, there were also no significant differences between both groups (Scopy: 73.5% vs. Open: 67.5%, p = 0.404). The same result was noted in stage III patients (Scopy: 57.9% vs. Open: 61.7%, p = 0.663). Comparing the 5-year disease free survival rate for all stages, both groups have a similar survival rate (Scopy: 68.3% vs. Open: 65.8%, p = 0.405). In stage I patients, there were no significant differences between both groups (Scopy: 71.4% vs. Open: 80.2%, p = 0.502). In stage II patients, there were also no significant differences between both groups (Scopy: 74.5% vs. Open: 65.2%, p = 0.272). The same result was noted in stage III patients (Scopy: 55.6% vs. Open: 58.4%, p = 0.610). Local recurrent rate was 1.18% in scopy group and 3.53% in open group. Conclusion. Based on research and experience, laparoscopic assisted right hemicolectomy is a safe and feasible technique.

並列關鍵字

Laparoscopic surgery ； Right hemicolectomy ； Colon cancer