CAJ | 학술논문

目的探讨腹腔镜手术治疗同时性胃肠道多原发癌的安全性和可行性.方法回顾性分析2009年1月至2014年1月中山大学附属第三医院19例行腹腔镜手术治疗同时性胃肠道多原发癌患者的临床资料.术后通过门诊或住院复诊、电话及信件方式随访,随访时间截至2014年4月或患者死亡.结果 19例患者手术顺利,其中腹腔镜辅助远端胃癌根治+直肠前切除术3例;腹腔镜辅助远端胃癌根治+胰十二指肠切除术1例;腹腔镜辅助右半结肠切除+胃体胃肠道间质瘤楔形切除术1例;腹腔镜辅助右半结肠切除+直肠前切除术4例;腹腔镜辅助左半结肠切除+直肠前切除术4例;腹腔镜辅助乙状结肠切除+直肠切除术6例.平均手术时间为228 min(145～ 380 min),辅助切口平均长度为5 cm(4～7 cm),术中平均出血量为86 mL(10～250 mL),无中转开腹患者.平均清扫淋巴结数目为39枚(21 ～58枚),平均阳性淋巴结数目为3枚(0～6枚).术后拔除腹腔引流管平均时间为3 d(2～6 d),术后恢复进食平均时间为4d(2 ～7 d),术后平均住院时间为10 d(7 ～21 d).术后并发切口感染1例,经对症处理后痊愈出院.患者术后平均随访时间为24个月(3 ～48个月),1例失访,12例无瘤生存,4例带瘤生存,2例因肿瘤相关原因死亡.结论腹腔镜手术治疗同时性胃肠道多原发癌是安全、可行的,且具有创伤小、恢复快的优点.
목적 탐토복강경수술치료동시성위장도다원발암적안전성화가행성.방법 회고성분석2009년1월지2014년1월중산대학부속제삼의원19례행복강경수술치료동시성위장도다원발암환자적림상자료.술후통과문진혹주원복진、전화급신건방식수방,수방시간절지2014년4월혹환자사망.결과 19례환자수술순리,기중복강경보조원단위암근치+직장전절제술3례;복강경보조원단위암근치+이십이지장절제술1례;복강경보조우반결장절제+위체위장도간질류설형절제술1례;복강경보조우반결장절제+직장전절제술4례;복강경보조좌반결장절제+직장전절제술4례;복강경보조을상결장절제+직장절제술6례.평균수술시간위228 min(145～ 380 min),보조절구평균장도위5 cm(4～7 cm),술중평균출혈량위86 mL(10～250 mL),무중전개복환자.평균청소림파결수목위39매(21 ～58매),평균양성림파결수목위3매(0～6매).술후발제복강인류관평균시간위3 d(2～6 d),술후회복진식평균시간위4d(2 ～7 d),술후평균주원시간위10 d(7 ～21 d).술후병발절구감염1례,경대증처리후전유출원.환자술후평균수방시간위24개월(3 ～48개월),1례실방,12례무류생존,4례대류생존,2례인종류상관원인사망.결론 복강경수술치료동시성위장도다원발암시안전、가행적,차구유창상소、회복쾌적우점.
Objective To investigate the safety and feasibility of laparoscopic resection for synchronous gastrointestinal multiple primary cancers.Methods The clinical data of 19 patients with synchronous gastrointestinal multiple primary cancers who received laparoscopic resection at the Third Affiliated Hospital of Sun Yat-Sen University from January 2009 to January 2014 were retrospectively analyzed.Patients were followed up via in-and out-patient examination,phone call or mail till April 2014 or death of the patients.Results The operation was successfully carried out on all the patients.Three patients received laparoscopic assisted distal gastrectomy + anterior resection of rectum; 1 received laparoscopic distal gastrectomy + pancreaticoduodenectomy ; 1 received laparoscopic assisted right hemicolectomy + gastric body wedge resection ; 4 received laparoscopic assisted right hemicolectomy + anterior resection of rectum; 4 received laparoscopic assisted left hemicolectomy + anterior resection of rectum; 6 received laparoscopic assisted proctosigmoidectomy.The mean operation time,length of assisted incision,volume of blood loss were 228 minutes (range,145-380 minutes),5 cm (range,4-7 cm) and 86 mL (range,10-250 mL),respectively.No patients were converted to open surgery.The mean number of lymph nodes dissected was 39 (range,21-58),and 3 lymph nodes (range,0-6) were positive.The time of drainage tube removal,time to food intake and duration of postoperative hospital stay were 3 days (range,2-6 days),4 days (range,2-7 days) and 10 days (range,7-21 days),respectively.One patient was complicated with incisional infection and was cured by symptomatic treatment.The mean time of follow-up was 24 months (range,3-48 months).One patient missed the follow-up,12 survived without tumor,4 were alive with tumor,and 2 died due to tumor related factors.Conclusion Laparoscopic resection for the treatment of synchronous gastrointestinal multiple primary cancer is safe and feasible,with advantages of little trauma and fast recovery.