腹腔镜辅助低位直肠癌保肛手术与传统开腹手术的疗效对比分析

Comparison of clinical effects between laparoscopic assisted and open sphincter-preserving radicalresection for low rectal cancer

目的探讨腹腔镜下低位直肠癌根治术的可行性、安全性及疗效。方法回顾性分析2007年至2009年我科行保肛手术的低位直肠癌患者,将其分为两组,腹腔镜辅助Dixon术式和常规开腹Dixon术,分析两组患者的临床资料及预后、复发资料。结果腹腔镜组与开腹组的一般资料如性别、年龄、术前合并症、肿瘤下缘距肛缘距离、TNM分期及Dukes分期比较,差异无显著统计学意义。腹腔镜组术中出血量、术后肛门排气时间及术后住院时间显著短于开腹组患者(P<0.05)。腹腔镜组淋巴结清扫数目稍多开腹组,分别为(16.4±4.3)、(14.1±3.7)个,差异有统计学意义(P=0.016)。腹腔镜组和开腹组肿瘤下缘安全切缘长度分别为(2.5±0.8)cm和(2.4±0.6)cm,无统计学差异(P=0.545)。开腹组术后切口感染的发生率显著高于腹腔镜组,两组患者吻合口瘘的发生率相近。腹腔镜组及开腹组5年累积生存率分别为62.4%及66.7%,无统计学差异(P>0.05)。结论腹腔镜低位直肠癌根治术能够达到开腹手术的根治效果,安全可靠,短期疗效良好,长期生存预后不逊于开腹手术,值得推广应用。

Objective To investigate the feasibility, safety and clinical effects of laparoscopic assisted sphincter-preserving radical resection for low rectal cancer. Methods From February 2007 to December 2009, the patients undergoing sphincter-preserving radical resection for low rectal cancer in our department were retrospectively reviewed and divided into laparoscopic assisted(n=39) and open(n=35)Dixon groups respectively. The clinicopathological and survival data were compared between the two groups.Results There were no differences in age, gender, pre-operative coexistent diseases, the distance from the inferior tumor margin to the anal level, TNM and Dukes stages between the two groups. The mean operative blood loss, the time for bowel function recovery, and hospital stay in the laparoscopic group were significantly decreased compared with the open surgery group(P<0.05). The average numbers of harvested lymph node were(16.4±4.3) and(14.1±3.7) respectively in the laparoscopic and open groups(P=0.016).The length of safe resection margin was(2.5±0.8)cm in the laparoscopic group and(2.4±0.6)cm in the open group(P>0.05). The incidence of incision infection was higher in the open group, however, there was no difference in the incidence of postoperative anastomotic fistula between the two groups. The 5-year survival rates was 62.4% and 66.7% respectively in the laparoscopic and open groups(P >0.05).Conclusion Laparoscopic assisted sphincter-preserving radical resection for low rectal cancer is a safe and feasible procedure, with the same good short-term effects and long-term survival as conventional open surgery.