腹腔镜与开腹直肠癌保肛手术的临床对比研究

Clinical comparison of laparoscopic and open anterior resection for rectal cancer with anal sphincter preservation

目的探讨腹腔镜直肠癌保肛手术的可行性、安全性及优越性。方法将2004年12月～2006年3月收治的可以行保肛手术直肠癌患者60例,随机分腹腔镜组和传统开腹组进行手术,对其临床资料进行比较分析。结果腹腔镜组29例,开腹手术28例。腹腔镜组术中出血量、手术切口长度、术后疼痛评分VAS、恢复肠道功能的时间和下床活动时间[(69±48)mL、(5.1±1.5)cm、(5.3±2.1)、(31±11)h和(2.5±1.2)d)]明显低于开腹手术组[(172±67)mL、(19.8±4.7)cm、(9.2±2.9)、(82±13)h和(7.2±2.8)d],腹腔镜组手术时间(172±36)min明显长于开腹手术组(142±47)min,两组之间差异均存在显著性,P<0.01。两组在肠段切除长度、肿块距下切缘距离和淋巴结清扫范围方面比较,差异无显著性,P>0.05。开腹手术组术中肉眼血尿、术后切口感染发生机会多于腹腔镜组,两组吻合口瘘的发生率基本相同。结论腹腔镜直肠癌根治手术创伤小,恢复快,安全可靠,对于能够按照TME原则进行手术保肛的直肠癌患者,能够取得与开腹手术同样的肿瘤根治性效果。

[Objective] To evaluate the feasibility, safety and advantage of laparoseopic anterior resection for rectal cancer with anal sphincter preservation. [Method] From December 2004 to March 2006, 29 patients with rectal cancer underwent anterior resection, while 28 patients received open procedure, the clinical data were collected and compared. [Results] The mean operative blood loss, the length of incision, the grade of pain after operation, the resuming time of bowel function, the time of resuming early activity [（69±48） mL, （5.1±1.5） cm, （5.3±2.1）, （31± 11） h, （2.5±1.2） d] in laparoseopic group were significantly lower than [（142±47） min, （19.8±4.7） cm, （9.2±2.9）, （82± 13） h, （7.2±2.8） d] in open group. P 〈0.01. The mean operating time in laparoseopic group （172±36） rain was significantly longer than （142±470） rain open group （P 〈0.01）. No significant difference were detected between two group in specimen length, distal margin and lymph node harvest. P 〉0.05. Vesical hematuria and infection in incision are more likely to take place in open group than in laparoscopic group. The rates of anastomotic leakage was almost same in two group. [Conclusions] Laparoseopic surgery is feasible, safe and minimally invasive technique for rectal cancer with anal sphincter preservation, which can get the same radical effect of TME compared with the traditional open procedure.