腹腔镜与开腹直肠癌手术的临床对比研究

Clinical Comparison of Laparoscopic Surgery and Open Procedure for Rectal Cancer

目的：探讨腹腔镜直肠癌手术的优越性和安全性。方法：自2007年1月至2008年4月，选择在我院行腹腔镜手术病例15例，开腹手术病例50例，比较手术中及术后情况。结果：腹腔镜组的手术时间为180-310min（平均为230．00±40．71min），开腹组的手术时间为100-240min（平均为123．60±24．31min），差异有显著性（P〈0．05）。腹腔镜组的术中出血量为30-350ml（平均为115．33±91．17m1），开腹组的术中出血量为100-500ml（平均为322．00±85．81m1），差异有显著性（P〈0．05）。腹腔镜组的术后肛门排气时间为1-4d（平均为1．93±0．70d），开腹组的术后肛门排气时间为3-10d（平均为5．00±1．20d），差异有显著性（P〈0．05）。腹腔镜组的术后治愈出院的时间为8-20d（平均为12．67±2．61d），开腹组的术后治愈出院的时间为10-19d（平均为14．88±2．82d），差异有显著性（P〈0．05）。腹腔镜组的术后并发症发生率为6．7％（1／15），开腹组的术后并发症发生率为22％（11／50），差异有显著性（P〈0．05）。腹腔镜组的术中清扫淋巴结数为20-29个（平均为23．60±3．14个），开腹组的术中清扫淋巴结数为4-45个（平均为21．96±7．10个），差异无显著性（P〉0．05）。结论：腹腔镜直肠癌根治术与开腹手术有同样的肿瘤根治效果，并具有出血少、术后并发症少、恢复快等优点，但必须由熟练且有经验的医师操作。

Objective： To evaluate the safety and advantage of laparoscopic surgery for rectal cancer. Methods： From January 2007 to April 2008,15 patients with rectal cancer underwent laparoscopic surgery, while 50 patients received open procedure . Their conditions were compared during operation and after operation. Results：The mean time of operation in laparoscopic group （230.00±40.71） min that was significantly lower than （123.60±24.31） min in open group, P 〈0.05. The mean operative blood loss in laparoscopic group （115.33±91.17） ml was significantly lower than （322.00±85.81） ml in open group. P〈0.05. The mean time of passage of gas by anus in laparoscopic group （1.93±0.70） day was significantly lower than （5.00±1.20） day in open group, P〈0.05. The mean healing time of after operation in laparoscopie group （12.67±2.61） day was significantly lower than （14.88±2.82） day in open group. P〈0.05. The incidence of postoperative complications in laparoscopic group 6.7% （1/15） was significantly lower than 22% （11/50） in open group, P〈0.05. There was no difference between the laparoscopic group （23.60±3.14） and the open group （21.96±7.10） in lymph node harvest, P〉0.05. Conclusions：The laparoscopic surgery can get the same radical effect compared with the traditional open procedure , It is less operative blood loss, less the incidence of postoperative complications and less mean healing time of after operation. It must be performed under the good indication by skilled and experience surgeon.