腹腔镜与开腹直肠全系膜切除保肛治疗低位直肠癌的临床研究

Clinical comparison of laparoscopic and open total mesorectal excision for sphincter preservation in the treatment of lower rectal cancer

目的 探讨腹腔镜下直肠全系膜切除保肛治疗低位直肠癌的可行性和近期临床疗效。方法 将我院2002年6月～2005年6月同期收治的低位或超低位直肠癌病人分为腹腔镜组（145例）和传统开腹组（152例）进行手术，对其临床资料进行回顾性分析。结果 腹腔镜组有6例中转开腹。两组均无手术死亡病例。两组手术时间分别为（167．5±49．3）min和（142．4±32．7）min，腹腔镜组时间长于开腹组，但无显著性差异（P〉0．05）。术中平均出血量分别为（78．4±25．6）ml和（131．5±45．5）ml，腹腔镜组明显少于开腹组（P〈0．05）。两组在肿块切除范围和淋巴结清扫范围方面比较，无显著性差异（P〉0．05）。肠道功能恢复时间分别为（2．4±1．0）d和（3．7±1．5）d，两组比较有显著性差异（P〈0．05）。术后并发症发生率分别为9．0％和11．2％，两组比较无显著性差异（P〉0．05）。局部复发率分别为7．2％和5．9％，无显著性差异（P〉0．05）。结论 腹腔镜直肠全系膜切除保肛治疗低位直肠癌能取得与开腹手术同样的肿瘤根治性效果，并具有出血少、肠功能恢复快、术后肛门括约肌功能及排尿功能良好等优点。

Objective To evaluate the effect of laparoscopic total mesorectal excision（LTME） and anal sphincter preservation on lower rectal cancer. Methods Form June 2002 to June 2005,145 cases of low rectal cancer were treated by LTME and anal sphincter preservation, while 152 patients with lower rectal cancer underwent open procedure. The curative effect and clinical data were collected and analyzed. Results In laparoscopic group,6 cases（4. 1%） were converted to open surgery. The mean operating time was （ 167. 5 ± 49.3） min in laparoscopic group, slightly longer than （ 142. 4 ±32. 7） min in open group（P〉0. 05）. The mean operative blood loss was （78. 4 ± 25.6）ml in laparoscopic group and （131.5 ± 45.5）ml in open group respectively（P〈0. 05）. There was no significant difference between two groups in specimen length and lymph node harvest. The intestinal function was restored earlier in laparoscopic group than that in open group（P〈0. 05）. The complication rate was 9. 0%and 11.2% （P〉0. 05）,and the local recurrence rate was 7. 2% and 5. 1% in laparoscopic group and open group respectively. Conclusion LTME and anal sphincter preservation is a feasible, safe and minimally invasion technique for the patients with low rectal cancer,which can get the same effect of open proeedure and provide better bowel function restored and less operative blood loss.