直肠癌全直肠系膜切除经腹腔镜与开腹手术的临床对照研究

Clinical controlled study of laparoscopy and laparotomy of rectal carcinoma

目的 :探讨经腹腔镜行全直肠系膜切除的可行性。方法 :36例直肠癌患者分别采用经腹腔镜或常规开腹手术行直肠癌根治术 ,比较两组围手术期的情况与切除标本 ,了解肿瘤切除的彻底性 ,肠旁淋巴结清扫数量的差异。结果 :两组切除标本的直肠系膜均完整 ;腹腔镜组与开腹组淋巴结数分别为 7 9± 0 7与 8 1± 0 9(P >0 0 5 ) ;直肠远切端均无癌细胞浸润 ;腹腔镜组失血 136± 2 1ml ,开腹组失血 35 7± 34ml,差异有高度显著性 (P <0 0 1) ,腹腔镜组手术后肠功能恢复早 (4 3± 5hvs 78± 12h ,P <0 0 5 ) ,围手术期并发症 2组无显著差别。结论 :在熟练掌握开腹全直肠系膜切除 (TME)的基础上经腹腔镜行TME是可行的 ,且患者创伤小、康复快 。

Objective:To evaluate the feasibility of laparoscopic TME and compare the short-term outcome of lap-aroscopic procedure with laparotomy for rectal carcinoma.Methods:Thirty-six patients with rectal carcinoma were includ-ed in a prospective non-randomized study.The patients were assigned to laparoscopic group(n=18)or laparotomy group(n=18).Case selection,surgical technique,and clinical and oncological results were reviewed.Results:Operative time was longer in LAP group than in laparotomy group(189±18min vs146±22min,P<0.05),and intraoperative blood loss were less in laparoscopic group than in the laparotomy group(136±21ml vs357±34ml,P<0.01).An earlier return of bowel function was observed after laparoscopic surgery(43±5h vs78±12h,P<0.05).The overall postoperative mor-bidity was5.6%in the LAP group and27.8%in laparotomy group(P>0.05).No anastomotic leakage was found in both groups.The pathologic examination showed that the length of the resected specimen and the mean number of lymph nodes in laparoscopic group were comparable to those in laparotomy group.Conclusions:Laparoscopic TME is a feasible and technical.The present study demonstrates that laparoscopic surgery for rectal carcinoma is feasible and safe procedure and oncological results are comparable to the laparotomy with a favorable short-term outcome.