腹腔镜与开放结肠切除术治疗结肠脾曲癌的长期结局比较

Comparison of long-term outcomes after laparoscopic-assisted and open colectomy for splenic flexure cancer

摘要:

摘要：目的??比较腹腔镜与开放结肠切除术治疗结肠脾曲癌的长期结局，采用倾向评分配比法（PSM）比较两者之间的差异。方法?回顾性分析2010年1月－2017年1月于该院行结肠切除术治疗的124例结肠脾曲癌患者的临床及随访资料。依据患者所行的手术方式，分为腹腔镜组及开放组。对患者采用PSM法进行1∶1匹配，匹配变量包括性别、体质指数（BMI）、临床分期及美国麻醉医师协会（ASA）分级。最终两组各有48例患者纳入研究。比较两组患者的短期及长期结局。结果?与开放组比较，腹腔镜组具有术中失血量较少、术后恢复较快及住院天数较短等特点。腹腔镜组与开放组的术后30 d并发症发生率比较，差异无统计学意义（P >0.05）；腹腔镜组与开放组的严重并发症发生率比较，差异无统计学意义（P >0.05）。两组患者的术中及术后30 d内死亡率均为0。腹腔镜组与开放组患者的病理结果（TNM分期、肿瘤分化状态等）比较，差异无统计学意义（P >0.05）。两组患者的肿瘤复发率、5年总体生存率及5年无瘤生存率比较，差异均无统计学意义（P >0.05）。结论?腹腔镜结肠切除术治疗结肠脾曲癌与开放手术相比较，具有较好的短期结局及类似的长期结局。

Abstract:

Abstract: Objective?To use propensity score matching to compare long-term outcomes after laparoscopic-assisted and open colectomy for splenic flexure cancer (SFC).?Methods?Clinical data of 124 SFC patients underwent colectomy from January 2010 to January 2017 were retrospectively analyzed. According to the surgical approach were used, the patients were categorized into laparoscopy group and open group. The patients were matched at a ratio of 1 : 1 using PSM, with the match variables including gender, body mass index, clinical stage, and American Society of Anesthesiologists score. 48 patients in each group were ultimately included in this study and their short- and long-term outcomes were compared.?Results?Compared with the open group, the laparoscopy group had less blood loss, faster postoperative recovery, and shorter hospitalization stay. There was no statistically significant difference in the incidence of postoperative 30 day minor or major complications between the two groups. The intraoperative mortality and postoperative 30-day mortality were all 0% between the two groups. There was no statistically significant difference in pathological results between the two groups. There was no statistically significant difference in the tumor recurrence, 5-year overall survival, and 5-year disease-free survival rates between the two groups.?Conclusion?Laparoscopic-assisted colectomy for SFC had the same long-term outcome as open colectomy.