腹腔镜手术对结直肠肿瘤微转移的影响.doc

腹腔镜手术对结直肠肿瘤微转移的影响 　　作者：刘晓东,罗琪,李文炼,杨丽华　　作者单位：福建医科大学教学医院厦门中山医院,福建 厦门，361004 　　【摘要】 目的：探讨腹腔镜手术对结直肠肿瘤淋巴结微转移的影响。方法：回顾分析Dukes C期结直肠肿瘤患者40例的临床资料，其中实验组18例行腹腔镜手术，对照组22例行传统开腹手术，免疫组化检测常规病理阴性的淋巴结中CEA的表达，计算两种术式淋巴结转移漏诊情况。结果：实验组清扫淋巴结146枚，平均8.11枚，常规病理阳性88枚，阳性率60.27%，常规病理阴性者表达CEA 8枚，漏诊率13.79%;对照组清扫淋巴结182枚，平均8.27枚，常规病理阳性112枚，阳性率61.54%，常规病理阴性者表达CEA 19枚，漏诊率27.14%。两组淋巴结清扫情况及常规病理结果差异无统计学意义(P0.05)，漏诊率差异有统计学意义(P0.01)。结论：两种术式在淋巴结清扫方面无显著差异，但腹腔镜手术淋巴结漏诊率明显低于传统开腹手术，说明此术式对结直肠肿瘤微转移的影响明显小于传统开腹手术。 　　【关键词】 结直肠肿瘤;直肠切除术;腹腔镜术;开腹术;微转移 　　【Abstract】 Objective:To investigate the effect of laparoscopic surgery on micrometastasis of colorectal cancer.Methods:The clinical data of 18 patients accepted laparoscopic colorectal surgery and 22 patients accepted open colorectal surgery were retrospectively analyzed.All the patients colorectal neoplasms were in stage of Dukes C.The expression of CEA in lymph nodes,which were negative in pathology examination,was detected by immunohistochemistry,and the missed diagnosis of lymph node metastasis was recorded and analyzed.Results:One hundred and fortysix lymph nodes were obtained(8.11 nodes on average) in patients accepted laparoscopic colorectal surgery,88 of them were positive in pathology examination(60.27%).8 nodes,which were negative in pathology examination,was positive in CEA expression(rate of missed diagnosis:13.79%).182 nodes were obtained(8.27 on average) in patients accepted open colorectal surgery,112 nodes were positive in pathology examination(61.54%),19 of negative in pathology examination were positive in CEA expression(rate of missed diagnosis:27.14%).There was no significant difference in lymph node dissection and pathology examination(P0.05).The difference in missed diagnosis between two groups was significant (P0.01).Conclusions:There is no significant difference in lymph node dissection between two groups.The rate of missed diagnosis of patients accepted laparoscopic colorectal surgery is significantly lower than accepted open colore