腹腔镜在直肠癌根治术中的应用

The application of laparoscopic radical resection for rectal carcinoma

目的:探讨腹腔镜手术治疗直肠癌的微创优势,提高直肠癌的疗效并减少并发症的发生。方法:回顾分析2002年5月至2007年10月山东大学齐鲁医院普外科收治的75例直肠癌患者的临床资料。患者随机分为两组:腹腔镜组和开腹组。腹腔镜手术组共33例,其中28例行直肠前切除术(Dixon术),5例行腹会阴直肠癌根治术(Miles术);开腹组42例,其中30例行Dixon术,12例行Miles术。比较两组的出血量、手术时间、并发症、术后恢复时间等指标。结果:腹腔镜组32例手术成功,1例中转开腹,平均手术时间200min(150～300min),术中平均出血100ml(30～400ml),术后肠功能平均恢复时间36h(24～50h),清除淋巴结10.9枚(4～20枚),术后4例切口感染,平均住院10.8d(7～19d)。开腹组平均手术时间140min(90～210min),术中平均出血170ml(80～500ml),术后肠功能平均恢复时间48h(36～72h),清除淋巴结12.3枚(4～19枚),术后6例切口感染,平均住院14.5d(9～22d)。两组在手术时间、出血量、术后恢复时间、手术并发症等方面差异均有统计学意义(P<0.01)。结论:腹腔镜直肠癌根治术具有明显的微创优势,安全可行,能达到开腹手术的根治效果。

Objective： To investigate the mini-invasive advantages of laparoscopic radical resection of rectal carcinoma, so as to improve the curative effect of laparoscnpic radical resection of rectal carcinoma and reduce its complications. Methods：The clinical data of 75 cases with rectal cancer from May 2002 to Oct. 2007 were analyzed retrospectively. They were randomly divided into 2 groups-laparoscopy group and laparotomy group. There were 33 patients in laparoscopy group （28 Dixon and 5 Miles） and 42 cases in laparotomy group （30 Dixon and 12 Miles）. The amount of hemorrhage, operative time, complications and postoperative recovery time were compared between two groups. Results：In taparoscnpy group,32 operations were successful and only one case emwerted to open surgery, the average operative time was 200rain （150-300min） , the mean amount of hemorrhage was 100ml （30--400ml） , the mean recovery time of intestinal function was 36h（ 24-50h ） , the mean number of lymph node harvesl was 10.9 （4-20） ,4 cases developed incision infection, the average hospitalization was 10.8d （7-19d）. In laparotomy group, the average operative time was 140min （ 90-210min）, the amount of hemorrhage was 170ml（80-500nd） , the mean recovery time of intestinal function was 48h（36-72h） , the mean number of lymph node harvest was 12.3 （4-19） ,6 eases developed incision infection, and the average hospitalization was 14.5d （9-223）. There were significant differences between the two groups in operative time,the amount of hemorrhage, recovery time after operation and complications （P 〈 0.01 ）. Conclusions： Laparoseopic radical resection of rectal carcinoma is safe,feasible and miuimally invasive, which acquires similar effect with open approach.