腹腔镜与开腹直肠癌低位前切除术后吻合口瘘发生率的比较

Comparison of the incidence rates of anastomotic leak following lower anterior resection of rectal cancer between laparoscopic and open operation

目的探讨腹腔镜与开腹直肠癌低位前切除术后吻合口瘘发生率的差异。方法2000年9月至2005年12月由同一组医师连续对距肛缘5～8cm的直肠癌患者实施腹腔镜下根治术（LP术组）53例及传统开腹根治术135例，比较两组和两组内患者造口与未造口者发生吻合口瘘的差异。结果LP术组造口与未造口者吻合口瘘的发生率分别为4．6％（1／22）与6．5％（2／31），X^2=0．088，P〉0．05；差异无统计学意义。OP术组造口与未造口者吻合口瘘的发生率分别为2．3％（1／43）与8．7％（8／92），X^2=1．024，P〉0．05；差异无统计学意义。LP术组与OP术组行造口的患者吻合口瘘发生率比较，P=0.455，差异无统计学意义；LP术组与0P术组未行造口者的吻合口瘘发生率比较，P=0．288，差异也无统计学意义。结论腹腔镜行直肠癌低位前切除术与开腹手术相比，不会增加吻合口瘘的发生率。

Objective To investigate and compare the incidence rates of postoperative anastomotic leak following laparoscopic（LP）versus open（OP）lower anterior resection for rectal cancer. Methods Fifty-three cases of LP and 135 cases of OP lower anterior resection with rectal cancer site 5-8 cm away from anal edge were oprerated by the same surgeon team from Sep. 2000 to Dec. 2005. The differences of postoperative anastomotic leak of protective stomy and non-protective stomy between LP and OP groups were analysed. Results In LP group, the incidence rates of the postoperative anastomotic leak of protective stomy and non-protective stomy were 4.6% （1/22）and 6.5%（2/31） respectively（P〉0.05, X2=0.088）. In OP group, the incidence rates were 2.3%（1/43） and 8.7%（8/92） respectively （P〉0.05,X^2=1.024）. No significant difference existed between LP and OP groups with protective stomy （P=0.455）, neither did LP and OP groups without protective stomy （P=0.288）. Conclusion Laparoscopic low anterior resection of rectal cancer is a safe procedure. It doesn＇t increase the incidence rate of anastomotic leak as compared to traditional open surgery.