腹腔镜结直肠癌切除术与同期开腹结直肠癌切除术的临床对比研究

Clinical controlled study of laparoscopic vs open cholectomy and rectomy for carcinoma

目的：比较腹腔镜结直肠癌切除术与同期开腹手术的临床疗效。方法：将2001年8月至2005年6月行结直肠癌切除的患者根据意愿分为接受腹腔镜手术和传统开腹手术2组,对比2组的手术安全性、术后恢复情况、肿瘤根治性、医疗费用和随访结果。结果：腹腔镜组和开腹组分别有36、30例患者入选,两组均无术中、术后严重并发症和手术死亡病例,腹腔镜组4例中转开腹手术;腹腔镜组术中失血量为（145.5±25.5）ml,显著少于开腹组（302.5±34.5）ml;下床时间和住院天数腹腔镜组分别,显著短于开腹组（68.4±4.5）h和（18.2±3.5）d。腹腔镜组手术切除标本边缘瘤细胞和清扫淋巴结总数与开腹组无显著差异（P〉0.05）;腹腔镜组25例随访（3-45）个月,平均（28.15±8.65）个月;开腹组随访（4-36）个月,平均（22.25±7.35）个月。两组短期（≤3年）累计生存率差异无显著性意义（P〉0.05）。结论：腹腔镜结直肠癌切除术安全、有效、具有可行性。

Objective： To compare the results of laparoscopic and open cholectomy and rectomy for colon and rectal carcinoma. Methods： We compared operation safety , recovery , complications , expenditure , lymph nodes clearance and short term outcome for the two groups of patients undergoing either laparoscopic or open operation for colon and rectal carcinoma. Results： Between August 2001 and May 2003 ,36 patients underwent a laparoscopic cholectomy or rectomy; 30 patients were treated via an open approach, 4 patients in the laparoscopic group were converted to open surgery. The mean blood loss in laproscopic group 145.5 ±25.5ml was less than that in open group 302.5 ± 34.5 ml. Complications were similar in the two groups （ P 〉 0.05 ） ; Time to resume early activity and hospital stay in laparoscopic group were 18.2 ±6.2h and 10.2 ±2.5 days respectively , which were significantly shorter than those in open group （ P 〈 0.05 ） . No significant difference between the two groups was observed for the lymph nodes clearance （P 〉 0.05 ） The mean follow up time of the two groups were 28.15 ± 8.65 and 22.25 ± 7.35 months , respectively. Local recurrence rate , metachronous , metastases rate and cumulative survival probability at 3 years were similar for the two groups. Conclusion： Laparoscopic chlectomy and rectomy for colon and rectal carcinoma can be performed safely , effectively with the advantages of minimal invasiveness.