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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RedineDB完成首例腹腔镜辅助结肠肠癌手术1991年由JacobsM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laparoscopicresectionofrectosigmoidcarcinoma: prospectiverandomisedtrial腹腔镜组N=203开腹组N=200P手术持续时间（min）189.9144.2<0.001失血量（m
2、l）1692380.006止痛剂注射次数4.56.90.003第一次排气2.43.1<0.001正常饮食时间4.24.9<0.001独立步行时间3.54.5<0.001住院天数8.28.7<0.001开始日常活动时间32.243.70.002远端切缘4.5cm4.5cm0.97清扫淋巴结11.112.10.18直接成本92977148<0.001LeungKL,etal.Lancet;2004,363,(9416),1187~1192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%（90/435
3、）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nengljmed350;2013,2004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1212Cost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Patientswerefollowedfor8years,with5-yeardataon90%ofpatie
4、nts.medianof7years(range5-10years).Disease-free5-yearsurvival(Open68.4%,Laparoscopic69.2%,P=0.94)Overall5-yearsurvival(Open74.6%,Laparoscopic76.4%,P=0.93)Overallrecurrenceratesweresimilarforthe2groups(Open21.8%,Laparoscopic19.4%,P=0.25)Theserecurrencesweredistributed
5、similarlybetweenthe2treatmentgroups(Open:wound0.5%,liver5.8%,lung4.6%,other8.4%;Laparoscopic:wound0.9%,liver5.5%,lung4.6%,other6.1%).CONCLUSION:Laparoscopiccolectomyforcurablecoloncancerisnotinferiortoopensurgerybasedonlong-termoncologicendpointsfromaprospectiverando
6、mizedtrial.AnnSurg.2007Oct;246(4):655-62;discussion662-4Long-termoutcomeoflaparoscopicsurgeryforcolorectalcancer: Acochranesystematicreviewofrandomisedcontrolledtrials.Results:Twelvetrials(3346patients)reportedlong-termoutcome腹腔镜和开放结直肠癌切除在切口疝和因肠粘连再手术方面无显著性差异(p=0.32an
7、d0.30,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=0.15and0.16forcolonandrectalcancer,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:Laparoscopicresectionofcarcinomaofthecolonisassociatedwithalong-termoutcomethatissimilartoth
8、atafteropencolectomy.Laparoscopicsurgeryforcanceroftheupperrectumisfeasible,butmorerandomisedtrialsneedtobeconductedtoassesslong-te
