结直肠癌开腹与腹腔镜下手术疗效的前瞻性研究

Laparoscopic vs Conventional Open Surgery for Colorectal Cancer: A Prospective Randomized Study

目的:探讨腹腔镜手术治疗结直肠癌的可行性及近期疗效。方法:2006年4月至2008年6月本院腹部外科收治的结直肠癌患者,以TNM分期为依据,随机分为腹腔镜组59例及常规开腹组70例,对比评估两组的肿瘤切除范围、淋巴结清扫数、术中出血量、手术时间、围手术期输血、术后肠道功能恢复时间、手术对患者机体血常规和生化指标的影响、住院天数、手术费用、术后并发症、复发及转移等。结果:腹腔镜组达到与开腹组同样的肿瘤切除范围和淋巴结清扫(15.28枚 vs 14.00枚,P>0.05)。腹腔镜组术中出血量少于开腹组(260.68mL vs 304.43mL,P>0.05)、术后肠道功能恢复时间明显早于开腹组(3.20d vs 4.30d P<0.05),术后住院天数短于开腹组(9.61d vs 13.06d,P<0.05)。手术时间腹腔镜组前期较开腹组长(196.97min vs 156.86min P<0.05),但后期两组无差异(143.85min vs155.00min P>0.05)。手术费用腹腔镜组高于开腹组(51 897.93元 vs 48010.62元人民币,P<0.05)。腹腔镜手术对患者血浆白蛋白ALB(35.561g/L vs 33.663g/L,P<0.05)、PALB(15.44g/L vs 13.61g/L,P<0.05)、Tp(65.685g/L vs 63.863g/L,P<0.05)的影响均较开腹手术者轻。两组随访期间各有并发症5例,并发症率7%～8%,术后转移1例。两组切口均无肿瘤种植、无局部复发及近期死亡病例。结论:腹腔镜结直肠癌手术符合肿瘤根治原则,可达到与开腹手术同样的根治性治疗效果,近期疗效令人满意,并具有切口小、创伤轻、术后恢复快、并发症少、住院时间短、术后生存质量高等优点。腹腔镜结直肠癌手术将有广泛推广应用的价值。

Objective： To investigate the feasibility and short-term clinical efficacy of laparoscopic surgery for colorectal cancer. Methods： From April 2006 to June 2008, a total of 129 cases of colorectal cancer seen in our hospital were recruited and were divided into 2 groups： laparoscopic surgery group （n=59） and conventional open surgery group （n=70）. The rate of radical surgery, the number of the dissected lymph nodes, blood loss, surgery duration, perioperative blood transfusion, the time needed for recovery of gastrointestinal function, blood routine examination and biochemical criterion, days of hospitalization, cost of treatment, complications, recurrence and metastasis were prospectively analyzed and evaluated. Results： The laparoscopic group and open surgery group had similar rate of radical surgery and the number of dissected lymph nodes was 15.28 and 14.00, respectively （P〉0.05）. The laparoscopic group had less amount of blood loss during surgery （260.68 vs.304.43, P〉0.05）. The time needed for recovery of gastrointestinal function in the laparoscopic group was significantly shorter than that in the open surgery group （3.20 days vs. 4.30 day, P〈0.05）. Patients in the laparoscopic group had shorter hospitalization than those in the open surgery group （9.61 days vs.13.06 days, P〈0.05）. In early period of surgery, the operation duration in the laparoscopic group was longer than that in the open surgery group （196.97 min vs. 156.86 min, P〈0.05）, but no significant difference was found in the operation duration during the latter period between the two groups （143.85 min vs. 155.00 min, P〉0.05）. The cost of laparoscopic surgery was higher than that of open surgery （51897.93 vs. 48010.62 RMB, P〈0.05）. Laparoscopic surgery had less effect on plasma albumin ALB （35.561 vs. 33.663, P〈0.05）, PALB （15.44 vs. 13.61, P〈0.05）, and Tp （65.685 vs. 63.863, P〈0.05）. Each group had 5 cases with complication during the follow-up period. The rate of complication was 7%-8% and there was 1 case with metastasis. Therewas no incision implantation, local recurrence or short-term death in both groups. Conclusion： Laparoscopic surgery is an option for radical treatment of colorectal cancer, with smaller incision, less wound, quick rehabilitation, fewer complications, shorter hospitalization and higher quality of postoperative life.