摘要
目的探讨内镜下无法切除的结直肠息肉的特征和外科治疗策略。方法回顾性分析2006年8月至2012年7月在中山大学附属第三医院胃肠外科行手术治疗的40例内镜下无法切除的结肠和高位直肠息肉患者的临床资料，应用单因素和多因素Logistic分析方法对可能影响息肉恶变的因素进行筛选，应用t检验和X2检验对比开腹和腹腔镜下结直肠肠段切除＋淋巴结清扫术的长短期预后数据。结果息肉恶变率为67．5％（27／40），与息肉恶变密切相关的是患者年龄和息肉个数（均P〈0．01）。开腹和腹腔镜下结直肠肠段切除＋淋巴结清扫术两种术式在手术失血量[（86±58）ml比（44±32）ml，P=0．0066]、恢复肛门排气时间[（2．7±1．3）d比（1．7±0．6）d，P=0．0018]、并发症发生率（2例比0例，P=0．0365）和住院时间[（11．2±1．0）d比（15．0±5．0）d，P：0．0164]方面差异均有统计学意义，在总生存率和无瘤生存率方面的差异均无统计学意义[90．9％（10／11）比100．0％（27／27）、90．9％（10／11）比96．3％（26／27），均P〉0．05]。结论内镜下无法切除息肉有高恶变率，息肉恶变多见于高龄患者和多发息肉患者。腹腔镜下结直肠肠段切除＋淋巴结清扫术比开腹手术的短期预后更好，长期疗效相仿，应作为内镜下无法切除息肉的首选术式。
Objective To explore the characteristics and risks of cancer in endoscopically unresectable polyps and compare the surgical outcomes of different operations. Methods A retrospective review of 40 patients undergoing surgical operations for polyps unresectable at colonoscopy between August 2006 and July 2012 from Department of Grastronintestinal Surgery was performed. The follow-up period was 3 to 72 months （median： 24. 5 months ）. Results The rate of endoscopically unresectable polyps with invasive cancer was 67. 5% （27/40）. And it was significantly influenced by patient age and number of polyps （ both P 〈 0. 01 ）. Perioperative volume of blood loss （ （ 86 ± 58 ） ml vs （44 ± 32 ） ml, P = 0. 0066 ）, time to first flatus （ （2. 7 ±1.3 ） d vs （ 1.7 ± 0. 6 ） d, P = 0. 0018 ）, incidence of complication （ 2 cases vs 0, P=0.0365） and hospital stay （（11.2±1.0）d vs （15.0±5.0）d, P=0.0164） were significantly different between open coletomy and laparoscopic group. And the long-term survival outcomes were similar in both groups （90.9%（10/11） vs 100.0% （27/27）, 90.9% （10/11） vs 96.3% （26/27）, both P 〉0.05）. Conclusions Endoscopically unresectable polyps of colon and rectum have high malignance rate. Polyps in elderly patients and multiple polyps are more likely to develop invasive cancer. Long-term outcomes are similar between open coletomy and laparoscopic coletomy groups, but laparoscopic group has better short- term outcomes. For endoscopically unresectable polyps, laparoscopic coletomy may be the first choice.
出处
《中华医学杂志》
CAS
CSCD
北大核心
2013年第8期588-591,共4页
National Medical Journal of China
关键词
结肠息肉
腹腔镜
结直肠肿瘤
Colonic polyps
Laparoscopes
Colorectal neoplasms
