1、腹腔镜辅助结直肠手术的历史 首例腹腔镜辅助结肠肠手术于 1991年Redine DB完成 首例腹腔镜辅助结肠肠癌手术 1991年由Jacobs M完成 香港、台湾、韩国、日本、欧美等国家开展比较普及 国内京津环渤海、珠三角、长三角、成渝较普及腹腔镜结直肠癌手术种类 完全腹腔镜手术 腹腔镜辅助手术 手助腹腔镜手术laparoscopic resection of rectosigmoid carcinoma:prospective randomised trial腹腔 镜组N=203开腹 组N=200P手 术 持 续时间 （ min） 189.9 144.2 0.001失血量（ ml） 169
2、238 0.006止痛 剂 注射次数 4.5 6.9 0.003第一次排气 2.4 3.1 0.001正常 饮 食 时间 4.2 4.9 0.001独立步行 时间 3.5 4.5 0.001住院天数 8.2 8.7 0.001开始日常活 动时间 32.2 43.7 0.002远 端切 缘 4.5cm 4.5cm 0.97清 扫 淋巴 结 11.1 12.1 0.18直接成本 9297 7148 0.001Leung KL, et al. Lancet;2004,363,(9416),11871192北美外科治疗临床疗效研究组（ COST）腹腔镜组 428例 开腹组 435例中转开腹 21%（
3、90/435）手术时间 150min对 90min术后恢复腹腔镜组更快住院时间更短 3d对 4d手术期间并发症术后 30日内死亡率术后 60天内并发症再入院率在手术率差异无显著性n engl j med 350;20 13, 2004切口长度手术时间口服镇痛药弱安定药住院日并发症根治性 Cost近端切缘远端切缘清扫淋巴结 12 12Cost研究肿瘤复发转移比较腹腔镜组16%开腹组18%Cost研究 3年生存率比较腹腔镜组86%开腹组85%Cost研究长期随访结果 Patients were followed for 8 years, with 5-year data on 90% of pat
4、ients. median of 7 years (range 5-10 years) . Disease-free 5-year survival (Open 68.4%, Laparoscopic 69.2%, P=0.94) Overall 5-year survival (Open 74.6%, Laparoscopic 76.4%, P=0.93) Overall recurrence rates were similar for the 2 groups (Open 21.8%, Laparoscopic 19.4%, P=0.25) These recurrences were
5、distributed similarly between the 2 treatment groups (Open: wound 0.5%, liver 5.8%, lung 4.6%, other 8.4%; Laparoscopic: wound 0.9%, liver 5.5%, lung 4.6%, other 6.1%). CONCLUSION: Laparoscopic colectomy for curable colon cancer is not inferior to open surgery based on long-term oncologic endpoints
6、from a prospective randomized trial. Ann Surg. 2007 Oct;246(4):655-62; discussion 662-4Long-term outcome of laparoscopic surgery for colorectal cancer:A cochrane systematic review of randomised controlled trials. Results: Twelve trials (3346 patients) reported long-term outcome 腹腔镜和开放结直肠癌切除在切口疝和因肠粘连
7、再手术方面无显著性差异 (p = 0.32 and 0.30, respectively) Trocar和切口部位转移上无显著性差异 (p = 0.16). 癌有关的死亡率在最大随访期内相似 (p = 0.15 and 0.16 for colon and rectal cancer, respectively) 腹腔镜与开放结肠癌切除术后癌复发转移无显著性差异 在随访期内腹腔镜与开放手术术后死亡率无显著性差异 Conclusions: Laparoscopic resection of carcinoma of the colon is associated with a long-term
8、 outcome that is similar to that after open colectomy. Laparoscopic surgery for cancer of the upper rectum is feasible, but more randomised trials need to be conducted to assess long-term outcome.Cancer Treat Rev (2008), doi:10.1016/j.ctrv.2008.03.011腹腔镜结直肠癌手术进展 手术根治性与开腹手术相同 标本长度、切缘阳性率及淋巴结检出数量等 ; 手术安全性好 术中并发症、术后总体并发症和具体并发症 ; 术后恢复快 腹腔镜手术术后疼痛更轻，排气时间、肠蠕动恢复时间、饮食恢复时间及出院时间均早于开腹手术组病人。 肿瘤治疗的远期效果不次于开腹手术 总存活率、无瘤存活率、肿瘤复发率。
