腹腔镜与开腹结肠癌切除术在中等体积中心的肿瘤切除质量评估

尽管存在肿瘤学安全性方面的担忧，但在过去几十年的几项试验中已证明腹腔镜手术治疗结肠癌优于开腹手术。 此外，腹腔镜手术的好处可以提供给其他患有恶性疾病的患者。 本研究的目的是在罗马尼亚的一个中等容量中心比较腹腔镜手术和开腹手术的非转移性可切除结肠癌的肿瘤切除质量，包括标本边缘和取回的淋巴结。 2017 年 1 月至 2020 年 12 月期间，共有 219 名非转移性结肠癌患者接受了手术。其中，52 名接受了腹腔镜切除术，167 名接受了开放手术。 腹腔镜组没有患者的圆周切缘阳性（P=0.035），而开腹组（OG）有 12 名（7.19%）患者切缘阳性。 腹腔镜组共有 3 名患者 (5.77%) 和 OG 组有 7 名患者 (4.19%) 侵犯了轴向边缘。 虽然清扫淋巴结的数量与手术类型无关[腹腔镜组16.12（14±6.56），OG 17.31（15±8.42），P = 0.448]，OG的淋巴结比例显著更高（P =0.003）。 鉴于本研究的结果，可以安全地得出结论，对于中等容量中心的非转移性结肠癌，腹腔镜手术并不逊于开腹手术。

长期以来，腹腔镜手术一直被认为是治疗恶性疾病，尤其是结肠癌。 切除范围、分期探查和套管针部位复发是引起关注的主要原因。 自 1990 年代第一次腹腔镜辅助干预结肠癌以来，十年后，两项大型多机构试验 COST 和 COLOR 证实，腹腔镜手术并不逊色，并且是非转移性可切除结肠开腹手术的可接受替代方法 癌症 。 自早期腹腔镜检查以来，已经取得了多项技术进步，从提供更好可视化的改进腹腔镜到伤口保护器、止血装置和出色的机械缝合。 因此，应该为患有恶性疾病的患者提供腹腔镜手术的固有优势，否则这些患者的切口会很大，住院时间会更长，并且可能难以重返工作岗位。

在过去的几十年中，越来越多的腹腔镜手术增加了人们对这种方法的信心。 此外，在了解恶性播散和肿瘤生物学的模式方面取得的一些进展导致了切除技术的标准化。 完全切除胚胎室而不是包含恶性肿瘤，因为结肠癌的完全结肠系膜切除术现在已被广泛接受，直肠癌的全直肠系膜切除术 (TME) 也是如此。 技术的标准化有助于缩短腹腔镜结肠癌切除术的学习曲线。

非转移性可切除结肠癌手术后结肠癌的肿瘤学清除率通过淋巴结采集和游离周向和轴向手术标本边缘的确认来评估。

本研究回顾性评估了腹腔镜和开腹手术两组之间非转移性结肠癌切除术的质量。 在埃利亚斯大学急诊医院外科的八名资深外科医生中，有两名常规进行腹腔镜结肠切除术。

腹腔镜与开腹结肠癌切除术在中等体积中心的肿瘤切除质量评估

图 1
右腹腔镜半结肠切除术。 回结肠蒂的识别和近端解剖，以及在 Fredet 筋膜平面上从十二指肠钝性分离右结肠系膜。 请注意 SMV 的突出显示过程。 SMV，肠系膜上静脉。

腹腔镜与开腹结肠癌切除术在中等体积中心的肿瘤切除质量评估

图 2
开放性右半结肠切除术，包括完整的结肠系膜切除术和 D3 淋巴结清扫术。 SMA 和 SMV 周围的淋巴结清扫。 虚线表示结肠系膜的内侧切除线。 SMA，肠系膜上动脉。 SMV，肠系膜上静脉。

腹腔镜与开腹结肠癌切除术在中等体积中心的肿瘤切除质量评估

图 3
乙状结肠癌伴前腹壁和膀胱侵犯的多脏器切除术。 多脏器切除术已实现负轴向和圆周切缘。

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