腹腔镜结直肠癌手术33例临床及随访总结

Laparoscopic operation for colorectal cancer:Clinical results of 33 cases

目的 评价腹腔镜大肠癌手术的优缺点。 方法 对 1996年 11月～ 2 0 0 2年 5月完成的 33例腹腔镜大肠癌手术病人进行随访 ,与同期有可比性的 39例病人资料进行比较。 结果 与开腹手术比 ,腹腔镜组前 15例手术时间较长 ( 2 0 2vs.15 1min ,P =0 0 0 2 ) ,16例以后与开腹手术时间相当 ( 14 1vs .15 1min ,P =0 377) ,术中出血量较少 ( 14 3vs.2 2 8ml,P =0 0 0 2 ) ,术后肠功能恢复快 ( 6 4 .1vs .74 9h ,P =0 0 0 0 )、住院时间短 ( 12 8vs.16 2d ,P =0 0 0 2 ) ,止痛剂用量少 ( 0 .5 5vs.1 4 9次 /人 ) ,手术并发症相近 ( 4 / 33vs .8/ 39,P =0 .341) ,1、3、5年生存率两组相似 ( 32 / 33vs .38/ 39,17/ 2 0vs.2 0 / 2 4 ,7/ 9vs.9/ 12 ;P=1 0 0 0 ) ,但清扫淋巴结数量少于开腹组 ( 7 4vs.9.8个 ,P =0 0 0 2 ) ,且费用较高 ( 2 380 0vs.184 0 0元 ,P =0 0 0 0 )。 结论 腹腔镜大肠癌手术安全 ,创伤小 ,达到与开腹手术相同效果 ,但费用较高 。

Objective To evaluate the advantages and disadvantages of laparoscopic colorectal operation. Methods Clinical records of 33 cases of laparoscopic colorectal operation from November 1996 to May 2002 were reviewed and compared with those of 39 comparable cases treated by conventional open surgery in the same period. Results As compared with the open group, the mean operation time in the laparoscopic group was longer in the previous 15 cases (202 vs 151 min, P =0.002) but equivalent in the subsequent 16 cases (141 vs 151 min, P =0.377). The laparoscopic group offered several advantages over open surgery, including less blood loss (143 vs 228 ml, P =0.002), quicker postoperative bowel function recovery (64.1 vs 74.9 hours, P =0.000), shorter length of hospital stay (12.8 vs 16.2 days, P =0.002), and less postoperative anodyne doses (0.55 vs 1.49 times per capita). The complication incidences (4/33 vs 8/39, P =0.341) and the postoperative 1-, 3-, 5-year survival rates (32/33 vs 38/39, 17/20 vs 20/24, 7/9 vs 9/12; P =1.000) bore no significant differences between the two groups. But in the laparoscopic group less average number of dissected lymph nodes (7.4 vs 9.8, P =0.002) and higher hospitalization costs (23 800 vs 18 400 yuan, P =0.000) were observed. Conclusions Laparoscopic procedures for colorectal cancer is safe and minimally invasive, which shows similar outcomes as compared with conventional surgery. But the medical expenses should be lowered and the lymph node clearance be improved.