腹腔镜直肠全系膜切除术治疗中、低位直肠癌的临床安全性对比研究

On the safety of laparoscopic total mesorectal excision for middle and lower rectal cancer

目的：探讨腹腔镜直肠全系膜切除治疗中、低位直肠癌手术的安全性。方法：回顾性对比分析我院2002年12月～2005年12月开腹直肠癌全系膜切除的病例（开腹组52例），以及2003年1月～2006年6月腹腔镜直肠癌全系膜切除的病例（腹腔镜组49例）。结果：腹腔镜组与开腹组一般资料差异无显著性。与开腹组比较，腹腔镜组术中出血量少[直肠癌前切除术（160±106）ml（n=37）vs（298±186）ml（n=36），t=-3．908，P=0．000；腹会阴联合直肠癌根治术（180±153）ml（n=10）vs（356±170）ml（n=14），t=-2．604，P=0．016]。腹腔镜组肠道功能恢复时间早于开腹手术组[（2．4±1．8）dVS（3．6±1．5）d，t=-3．648，P=0．000]。腹腔镜组总并发症的发生率低于开腹组[14．3％（7／49）g844．2％（23／52），x^2=10．834，P=0．001]。两组清扫淋巴结的数目无差异（12．7±6．5VS13．6±7．0，t=-0．668，P=0．505），下切缘均为阴性。腹腔镜组45例（91．8％）随访2～42个月，开腹组47例（90．4％）随访6～42个月，局部复发率分别4．4％（2／45）、4．3％（2／47）。结论：腹腔镜直肠全系膜切除治疗中、低位直肠癌安全、可行。

Objective To study the safety of laparoscopic total mesorectal excision for middle and lower rectal cancer. Methods A retrospective comparison was made between 52 cases of open total mesorectal excision from December 2002 to December 2005 （Open Group） and 49 cases of laparoscopic mesorectal excision from January 2003 to June 2006 （Laparoscopic Group）. Results There was no difference in baseline parameters between the two groups. As compared with the Open Group, the Laparoscopic Group presented less blood loss [for anterior resection： 160 ± 106 ml （n =37） vs 298 ± 186 ml （n =36） , t = -3. 908, P =0. 000; for abdominoperineal resection： 180 ± 153 ml （n = 10） vs 356 ± 170 ml （n = 14） , t = - 2. 604, P = 0. 016 ]. The recovery time of bowel functions was shorter in the Laparoscopic Group than in the Open Group （ 2.4 ± 1.8 d vs 3.6± 1.5 d ; t = - 3. 648, P = 0. 000）. The overall complication rate in the Laparoscopic Group （ 14.3% , 7/49） was lower than that in the Open Group （44.2% , 23/52） （X^2 = 10. 834, P =0. 001 ）. No significant difference was seen between the two groups in the number of lymph node resected （ 12. 7±6.5 vs 13.6±7.0 ; t = - 0. 668, P = 0. 505 ） , with negative margins in both groups. Follow-up observations were carried out in 45 cases in the Laparoscopic Group （91.8%） for 2 ～42 months and in 47 cases in the Open Group （90.4%） for 6 ～42 months, respectively. The local recurrence rate was respectively 4.4% in the Laparoscopic Group （2/45） and 4.3% in the Open Group （2/47）. Conclusions Laparoscopic total mesorectal excision for middle and lower rectal cancer is safe and feasible.