腹腔镜全直肠系膜切除术治疗中低位直肠癌

Experience of laparoscopic total mesorectal excision for middle or low rectal cancer

目的探讨腹腔镜全直肠系膜切除（TME）手术治疗中低位直肠癌的效果。方法2004年11月至2007年6月间在天津市人民医院行腹腔镜TME手术者83例，行开腹手术者85例，分别对两组患者的手术标本切缘、检出淋巴结数目以及手术并发症的发生率进行比较。结果腹腔镜TME手术组患者手术切缘与肿瘤之间的距离为（3．21±1．25）cm，明显长于开腹手术组[（1．15±1．11）cm，P=0．001]。腹腔镜TME手术组患者的淋巴结检出数为（12．53±1．88）枚，明显多于开腹手术组[（10．85±1．81）枚，P=0．01]。腹腔镜TME手术组和开腹手术组患者并发症的发生率分别为12．0％和23．5％，差异有统计学意义（P：0．026）。腹腔镜TME手术组患者术后进食的时间和使用止痛剂的时间分别为（2．43±1．06）d和（2．53±1．01）d，开腹手术组分别为（3．67±1．13）d和（4.55±1．78）d，腹腔镜TME手术组患者术后进食时间和使用止痛剂的时间均明显短于开腹手术组（P=0．005和P=0．008）。结论腹腔镜TME手术治疗中低位直肠癌是一种较为安全的术式，治疗效果与开腹手术相同，而且患者并发症的发生率和术后恢复情况均优于开腹手术。

Objective To study the feasibility and safety of laparoscopic surgery for middle or low rectal cancer. Methods 83 patients with middle or low rectal cancer received laparoscopic surgery and 85 patients received conventional open surgery. The cutting edge of specimens and number of lymph nodes were analyzed retrospectively. Results The mean distance between resected margin and the tumor was 3.21± 1.25 cm in laparoscopic operation group, while it was 1.15 ±1.11 cm in the open surgery group （P = 0. 001 ）. The mean number of disected lymph nodes was 12.53 ±1.88 in the laparoscopic operation group and 10.85±1.81 in the open operation group （ P = 0.01 ）. The incidence of postoperative complications was 12.0% in the laparoscopic operation group and 23.5% in the open operation group （P =0.026）. The mean time of food intake and using analgesics after surgery were 2.43 ± 1.06 days and 2.53± 1.01 days, respectively, in the laparoscopic operation group, while the corresponding figures were 3.67 ± 1.13 days and 4.55 ±1.78 days, respectively, in the open operation group（P =0.005, P =0.008）. Conclusion Laparoscopic surgery is a safe and effective procedure for middle or low rectal cancer, with less postoperative complications and better recovery after treatment.