腹腔镜与开腹结直肠癌疗效对比分析

Comparative analysis of laparoscopic surgery and laparotomy for colorectal cancer

目的探讨腹腔镜下结直肠癌手术的临床效果。方法回顾分析1996年11月至2006年9月行腹腔镜结直肠癌手术的110例临床资料,并与同期的123例开腹手术进行比较。结果与开腹手术比,腔镜组手术时间略长[(148.0±65.0)Vs(139.0±37.4)min,P=0.000],术中出血量较少[(137.1±128.6)Vs(209.3±101.3)mL,P=0.031],术后肠功能恢复快[(63.7±9.3)Vs(75.2±11.4)h,P=0.072],术后住院天数短[(13.8±5.2)Vs(17.2±5.2)d,P=0.027],手术并发症少,1、3、5年生存率(97.7%、84.7%、66.7%)与开腹组(97.1%、83.1%、67.6%,P=0.051)相近,但清扫淋巴结数量略少于开腹组[(9.1±5.2)Vs(11.2±3.4),P=0.404],且费用较高[(26.8±11.3)Vs(22.5±13.4)千元,P=0.209]。结论腹腔镜大肠癌手术安全、创伤小、并发症少,达到与开腹手术相同的远期效果,但需降低费用,淋巴结清扫有待于加强。

Objective To study the clinical effect of laparoscopic colorectal surgery. Methods Clinical data of 110 cases underwent laparoscopic colorectal surgery from November 1996 to August 2006 were retrospectively reviewed and compared with those of 123 comparable patients treated by conventional laparotomy in the same period. Results Comparing with laparotomy group, there was longer mean operative time, less blood loss during operation, shorter postoperative bowel function recovery time, shorter postoperative hospitalization days, less complications, less average number of lymph nodes dissected and higher hospitalization costs in laparoscopic surgery group. The postoperative 1-, 3-,Syear survival of laparoscopic surgery group was 97.1% ,83.1%, 67.6% , respectively, equivalent to that of laparotomy surgery（ P 〉 0.05 ）. Conclusion Laparoscopic colorectal surgery for colorectal cancer is safe, with minimal invasion and rare complications. It can achieve long-term effect as conventional laparotomy. But the medical expenses must be lowered and systemic lymph node clearance should be improved.