探讨高龄患者3D腹腔镜无切口直肠癌肝转移同期手术的可行性。

回顾性分析2015年3月至2017年3月在同济大学附属东方医院行同期手术治疗的56例高龄直肠癌肝转移患者（≥80岁）的临床资料，其中3D腹腔镜无切口手术43例（无切口组），直肠肿瘤切除采用经直肠腔内拖出式或经直肠腔翻出式，肝脏肿瘤同期切除；开腹手术13例（开腹组），比较两组患者在手术时间、出血量、住院时间、VAS疼痛评分、初次肛门排气时间、初次进食流质时间、淋巴结检出数、下切缘长度、术后并发症以及1年无病生存期（DFS）等方面的差异。

两组手术时间比较，差异无统计学意义（t=1.887，P=0.375）。与开腹组患者相比，无切口组患者的平均出血量更少，初次肛门排气时间、初次进食流质时间、术后平均住院时间更短，术后VAS疼痛评分更低，差异均有统计学意义（t=7.841、16.118、12.105、3.803、10.922，均P<0.01）。无切口组9例（20.9%）发生不同程度的术后并发症，其中Clavien-Dindo分级Ⅰ级7例，Ⅱ级2例；开腹组患者术后Ⅰ级并发症3例（23.1%）。两组并发症发生率及严重程度比较，差异无统计学意义（Z=1.342，P=0.180）。无切口组和开腹组标本下切缘长度分别为（3.9±1.3）cm、（4.0±1.7）cm，术后淋巴结检出数分别为（13.1±4.6）枚、（13.5±2.8）枚，差异均无统计学意义（t=0.226、0.296，P=0.835、0.773），术后1年DFS分别为62.8%、61.5%，差异无统计学意义（χ²=0.007，P=0.935）。

与开腹手术相比，腹部无切口直肠癌肝转移同期手术安全可行，且能减少术后出血量、缩短术后恢复时间并减轻患者疼痛。

To explore the feasibility of 3D laparoscopic incision-free simultaneous resection for elderly patients with rectal cancer and liver metastasis.

From March 2015 to March 2017, the clinical data of fifty-six cases (aged over eighty) with low rectal cancer and simultaneous liver metastasis operated in the Affiliated Shanghai East Hospital of Tongji University were retrospectively analyzed. Forty-three cases underwent 3D laparoscopy surgery without incision (incision-free group) which was described as transrectal extraction of specimen and transanal endorectal eversion and transection, and thirteen cases underwent open surgery (open group). Liver resection was simultaneously performed for liver metastases. The operation time, amount of bleeding, hospitalization length after operation, VAS pain score, interval to first flatus, interval to first oral intake, postoperative lymph node number, tumor resection margin length, postoperative complication rate and disease free survival (DFS) rate were analyzed between the two groups.

There was no significant difference in operation time (t=1.887, P=0.375). Compared with the open group, the bleeding, interval to first flatus, interval to first oral intake and average hospitalization length after operation were less and VAS scores were lower in incision-free group, the differences were significant (t=7.841, 16.118, 12.105, 3.803, 10.922, all P<0.01). Postoperative complications occurred in nine cases (20.9%) of the incision-free group, including Clavien-Dindo grade in seven cases and grade Ⅱ in two cases, grade complications occurred in three patients (23.1%) in the open group. There was no significant difference in the incidence and severity of complications between the two groups (Z=1.342, P=0.180). The length of lower incision margin in incision-free group and open group were (3.9±1.3) cm and (4.0±1.7) cm,the number of lymph nodes detected after operation were (13.1±4.6) and (13.5±2.8) respectively, with no significant differences (t=0.226, 0.296, P=0.835, 0.773). There was no significant difference in the 1-year DFS between the two groups (62.8% vs 61.5%, χ2=0.007, P=0.935).

Transanal specimen extraction-laparoscopic simultaneous resection in low rectal cancer with liver metastasis is safe and feasible, and may reduce postoperative bleeding, shorten postoperative recovery time and relieve pain of patients.