腹腔镜与开腹全直肠系膜切除保肛术治疗低位直肠癌临床对比的研究

Clinical comparison of laparoscope versus iaparotomy total mesorectal excision with anal sphincter preservation for low rectal cancer

目的比较腹腔镜与开腹全直肠系膜切除保肛术在低位直肠癌治疗中的临床应用。方法将2006年1月至2008年6月收治的106例低位直肠癌患者根据意愿分别接受腹腔镜手术（腹腔镜组，51例）和传统开腹手术（开腹组，55例），对比两组的手术安全性、疗效和随访结果。结果两组均无术中、术后严重并发症和手术死亡病例，保肛率100％。腹腔镜组排气时间、进半流食时间、住院时间分别为（2．4±0．6）、（5．4±0．6）、（9．2±3．2）d，与开腹组比较差异有统计学意义（P〈0．01或〈0．05）；腹腔镜组切除标本长度为（15．4±1．4）cm，肿瘤下缘距切缘距离为（5．4±1．2）cm，清扫淋巴结数目为（8．5±2．4）个，与开腹组比较差异无统计学意义（P〉0．05）。腹腔镜组35例（68．6％）和开腹组39例（70．9％）在1个月内恢复控便能力；术后随访6～36个月，两组均无腹壁切口种植、局部复发以及死亡病例。结论腹腔镜全直肠系膜切除保肛术治疗低位直肠癌能取得与开腹手术同样的肿瘤根治性效果，并具有创伤小、出血量少、术后恢复快等优点，是切实可行的微创手术。

Objective To compare the results of laparoscope and laparotomy total mesorectal excision （TME） with anal sphincter preservation in the treatment of low rectal cancer. Methods From January 2006 to June 2008, 106 patients with low rectal cancer which the distance from the lowest margin of tumor to the dentate line ranged from 3.0 to 7.0 cm underwent TME with anal sphincter preservation. Among them, 51 patients received laparoscope operation （laparoscope group） and the other 55 patients received laparotomy （laparotomy group） according to their wills. Results Two groups had no serious complications and death case after surgery, the rate of sphincter preservation was 100%. Blood loss was （ 20.2 ± 5.7 ） ml in laparoscope group, which was significantly less than that in laparotomy group （P 〈 0.01 ）, aerofluxus ,time to eat half-flow food and hospital stay were （2.4 ±0.6）, （5.4 ± 0.6） and （9.2 ±3.2 ） days respectively, which were significantly shorter than those in laparotomy group （P〈 0.01 or 〈 0.05）. Bowel function was back to normal in 35 patients of laparoscope group （68.6%） and 39 patients of laparotomy group （70.9%） within 1 month. All patients were followed-up from 6 to 36 months, there were no recurrence in situ local recurrence and mortality in the both groups. Conclusion Laparoscope TME with anal sphincter preservation can be achieved the same effect of oncological clearance, it is feasible and it is a minimal invasive and perspective technique with the benefits of much less blood loss during operation, higher rate of sphincter preservation, earlier return of bowel function and shorter hospitalization.