腹腔镜与开腹直肠癌全系膜切除术的对照研究

Laparoscopic vs open total mesorectal excision in the treatment of low rectal cancer

目的比较腹腔镜与开腹直肠癌全系膜切除术的疗效，评价腹腔镜直肠癌全系膜切除术的可行性与安全性。方法将2004--2007年收治的25例腹腔镜直肠癌根治术（Dixon）作为实验组，并按年龄、性别、肿块下缘距肛门距离、Dukes分期等匹配条件从同期开腹直肠癌手术（Dixon）中抽取25例作为对照组，比较两组的手术风险、术后恢复和随访结果。数据采用t检验、χ2检验。结果腹腔镜组25例中1例转改良Bacon手术。两组手术时间分别为（197±36）min和（172±51）min，差异有统计学意义（t=2．12，P=0．04）。术中平均出血量分别为（157±105）ml和（304±237）ml，腹腔镜组明显少于开腹组（t=-2．95，P=0．01）。两组肠段切除长度和清扫淋巴结数目比较，差异无统计学意义（t值分别为1．94、-0．77，P〉0．05）。肠道功能恢复的时间：腹腔镜组为（2．9±0．9）d，开腹组为（4．3±1．2）d，两组差异有统计学意义（t=-4．04，P=0．00）。术后并发症发生率分别为16％和28％，两组差异无统计学意义（χ2=1．05，P=0．31）。局部复发率分别为8％和4％，两组差异无统计学意义。结论腹腔镜直肠癌全系膜切除术安全、可行，创伤小，远期疗效与开腹手术相近。

Objective To evaluate the feasibility, safety and outcome of laparoscopic total mesorectal excision with sphincter preservation in the treatment of low rectal cancer. Methods From April 2004 to April 2007, laparoscopic total mesorectal excision with sphincter preservation for low rectal carcinoma was performed in 25 cases. The intraoperative risk, recovery, short-term and oncological outcomes of these patients were compared with 25 cases of conventional Dixon＇s operation. The controls, matched for age, sex, mass margin distance from the anus, Dukes stage, were selected from conventional Dixon＇s operations performed at the same period as laparoscopic group. T test and Chi-square test were used. Results Laparoseopic procedure was successful in 24 cases while one was converted to Bacon operation. The mean operation time （197 ± 36） min in laparoscopic group was significantly longer than those （172± 51） min in open group （t =2.12,P =0.04）. The mean operative blood loss was （157 ± 105） ml in laparoscopic group and （ 304 ± 237 ） ml in open group （ t = - 2. 95, P = 0. 01 ）. No significant differences were detected between two groups in specimen length and number of lymph nodes excised. The bowel function was restored earlier in laparoscopic group than that in open group. The overall morbidity rates were 16% and 28%, and the local recurrence rates were 8% and 4% in the two groups respectively. Conclusion Laparoscopic total mesorectal excision is a feasible, safe, minimally invasive technique for rectal cancer, which provides better short-term outcomes and similar oncological outcomes compared with the traditional open procedure.