改良腹腔镜Dixon手术和开腹Dixon手术的临床对照研究(附58例报道)

Comparison of Clinical Course Between Modified Laparoscopic Dixon Surgery and Open Dixon Surgery for Rectal Cancer with 58 Cases

目的探讨改良的腹腔镜Dixon手术治疗直肠癌的安全性和可行性。方法准确记录改良的腹腔镜Dixon手术(腔镜组)的临床资料,包括手术时间、术中出血量、淋巴结清除数目、术后腹腔引流量、肛门排气时间、住院时间以及吻合口漏、输尿管损伤、排尿障碍、大便失禁等并发症的发生情况,以同期开腹Dixon手术(开腹组)作为对照进行分析。结果从2007年9月到2008年7月期间共58例直肠癌患者入选本研究,其中腔镜组25例,开腹组33例。58例均顺利完成手术。术后发生吻合口漏腔镜组2例,开腹组1例,均经保守治疗好转。无输尿管损伤、排尿障碍、大便失禁等其他并发症。手术时间、术中出血量和淋巴结清除数在2组间的差异均无统计学意义(P>0.05)。腔镜组术后腹腔引流量比开腹组少(P<0.05),肛门排气时间和住院时间比开腹组短(P<0.05)。结论改良的腹腔镜Dixon手术治疗直肠癌是安全、可行的,同时能体现手术的微创性。

Objective To study the safety and feasibility of modified laparoscopic Dixon surgery for rectal cancer. Methods In the procedure of modified laparoscopic Dixon surgery, the rectum with tumor was pulled out and cut and colon-rectum anastomosis was performed through anus. The clinical data of patients with rectal cancer between modified laparoscopic Dixon surgery （laparoscopy group） and open Dixon surgery （open group） were compared and analysed prospectively. The clinical data included operative time, volume of bleeding, number of lymph node dissection, volume of abdominal drainage, time to bowel gas passage, hospital stay and relative complications, such as anastomotic leakage, ureteral injury, dysuria and fecal incontinence. Results Fifty-eight cases were selected in this study between September 2007 and July 2008, including 25 laparoscopic surgery in laparoscopy group and 33 open surgery in open group. Patient＇s data on gender, age, distance between tumor and anus edge, tumor diameter, tumor pathologic type and Dukes stage were similar between two groups by statistic analysis （P〉0.05）. All the operations were performed successfully. Two cases experienced anastomotic leakage in laparoscopy group, while 1 case experienced anastomotic leakage in open group. All these patients got recovered by conservative treatment at last. No other complications were experienced, such as ureteral injury, dysuria, fecal incontinence, and so on. There were no significant differences in term of operative time, volume of bleeding and number of lymph node dissection between two groups （P〉0.05）. The volume of abdominal drainage was less while the time to bowel gas passage and hospital stay were shorter in laparoscopy group than those in open group （P〈0.05）. Conclusion This study reveals that it is safe and feasible to perform modified laparoscopic Dixon surgery for rectal cancer, and it presents the character of minimal invasion.