腹腔镜辅助性全系膜切除保肛治疗中低位直肠癌的探讨

Study of laparoscopic total mesorectal excision for sphincter preservation in the treatment of middle and low rectal cancer

目的探讨腹腔镜辅助性直肠全系膜切除保肛治疗中低位直肠癌的可行性、安全性和近期临床疗效。方法收集我院2003年6月～2006年8月收治的中低位直肠癌病人79例,分腹腔镜组(24例)和传统开腹组(55例),对其临床资料进行回顾性分析。结果腹腔镜组有1例因骨盆狭小,腹腔镜下操作困难而中转开腹;手术中出血量少分别为(155±25)ml与(255±34)ml,有显著性差异(P<0.05);手术时间分别为(143±40)min和(111±32)min,但无显著性差异(P>0.05);手术后肠功能恢复时间分别为(46±3.5)h与(68±10.5)h,有显著性差异(P<0.05);术后并发症发生率分别为12.5%和10.9%,两组比较无显著性差异(P>0.05);腹腔镜组与开腹组获得的淋巴结数分别为(4.5±3.2)枚与(5.8±2.4)枚(P>0.05),两组在淋巴结清扫范围方面无显著性差异(P>0.05)。结论腹腔镜辅助下直肠全系膜切除保肛治疗中低位直肠癌可行、安全,能取得与开腹手术同样的肿瘤根治性效果,并具有出血少、肠功能恢复快等优点。

Objective To evaluate the feasibility, safety and short-term outcome of laparoseopic total mesorectal excision（LTME） and anal sphincter preservation on middle and low rectal cancer.Methods From June 2003 to Aug 2006,24 cases of middle and low rectal cancer were treated by LTME with anal sphincter preservation,while 55 cases were underwent open total mesorectal excision（OTME）.The chnical data were collected and analyzed retrospectively.Results In LTME group, 1 cases（4.1%） was converted to open surgery. The mean blood loss was（155±25）ml in LTME group and （255±34）ml in OTME group respectively（P〈0.01）.The mean operating time was （143±40）min and （111±32）min respectively（P〉0.05）.The intestinal function recovery was earlier in LTME group （46±3.5）h than that in OTME group （68±10.5）h （P〈0.05）.The complication rate was 12.5% and 10.9% respectively.（P〉0.05） There was no significant difference between two groups in lymph node harvest, （4.5±3.2） and （5.8±2.4） respectively（P〉0.05）.Conclusion LTME and anal sphincter preservation is a feasible and safe for the patients with middle and low rectal cancer, which can get the same effect with OTME and provide less surgical traurma and bowel function.