腹腔镜与开腹低位直肠癌全直肠系膜切除术的临床对照研究

Randomized control study of comparison of laparoscopic and open total mesorectal excision for lower rectal cancer

目的随机对照研究探讨腹腔镜下低位直肠癌TME的可行性及短期治疗效果。方法将69例Duke分期A或B期的低位直肠癌患者随机分为2组,分别行腹腔镜和常规开腹TME手术,比较两组患者围手术期情况、术后并发症以及术后复发和转移情况。结果腹腔镜组平均手术时间、术中出血量、术后肠功能恢复时间分别为(110.8±31.34)h、(84.41±28.41)ml、(2.59±0.99)d,而开腹手术组分别为(133.94±21.01)h、(143.94±34.18)ml、(4.0±1.06)d,差异有统计学意义。淋巴结清扫数目以及术后并发症发生率两组间无显著性差异。腹腔镜手术组保肛率明显高于开腹手术组(85.7%vs.61.8%,P<0.05)。中位随访39.5年,腹腔镜与开腹手术组局部复发分别2例、1例,远处转移分别2例、3例,差异无统计学意义。结论腹腔镜下全直肠系膜切除术治疗低位直肠癌安全可行,短期疗效确切。

Objective To evaluate feasibility of laparoscopic total mesorectal excision(TME) for lower rectal cancer and its short-term outcomes. Methods Sixty-nine lower rectal cancer patients with Duke's A and B stages were randomly assigned to laparoscopic surgery group(n=35)or open surgery group(n=34). Peri-operative indexes, postoperative complications and short-term recurrence or metastasis were compared between the two groups. Results The mean operating time, intra-operative bleeding volume and post-operative bowel function recovery time were(110.8±31.34)h,(84.41±28.41)ml,(2.59±0.99)d in laparoscopic surgery group,while(133.94±21.01)h,(143.94±34.18)ml,(4.0±1.06)d in open group(all P<0.01). There were no significant differences in number of lymph nodes harvested and complication rate between the two groups. The proportion of sphincter-preserving operations in laparoscopic group was significantly higher than that in open group (85.7% vs. 61.8%, P<0.05). After a median follow-up of 39.5 months, local recurrence occurred in 2 and 1 cases, metastasis in 2 and 3 cases respectively in laparoscopic and open groups. Conclusion Laparoscopic TME for lower rectal cancer is safe and feasible with definite short-term outcomes.