腹腔镜与开腹结直肠癌根治术对腹膜结构损伤的前瞻性对照研究

Peritoneal structural injury in laparoscopic versus open radical resection for colorectal cancer： a prospective controlled study

目的探讨腹腔镜与开腹结直肠癌根治术对腹膜结构损伤的差异。方法将符合纳入标准的50例结直肠癌患者分为腹腔镜组（LO组，27例）和开腹组（CO组，23例），前瞻胜比较两组手术时间、术中失血量、淋巴结清除数及其阳性数目、肠管切除长度、肿瘤距两端切缘距离和切缘病理学：采用光镜和扫描电镜观察两种手术方式对腹膜结构损伤的程度。结果L0组手术时间比CO组短[（150．6±39．5）min比（183．0±39．2）min，P〈0．05]，失血量显著少于CO组[（80．0±75．2）ml比（234．5±235．3）ml，P〈0．01]。两组切除标本长度、肿瘤距两端切缘距离、清除淋巴结总数及淋巴结阳性数目差异均无统计学意义（P〉0．05）。两组标本切缘均为阴性。光镜观察：CO组肠管浆膜完整性受损程度、系膜脂肪细胞与间皮细胞覆盖脱失程度、红细胞及炎性细胞聚集程度均较LO组严重（P〈0．01）；扫描电镜观察：CO组结直肠浆膜覆盖完整性受损程度、间皮改变程度和基底膜暴露程度均较LO组严重。结论在达到同等根治切除清扫程度下．腹腔镜结直肠癌根治术比传统开腹手术对腹膜结构损伤轻。

Objective To assess the differences in peritoneal microstructure injury between laparoscopic and open radical resection for colorectal cancer. Methods A total of 50 patients with colorectal cancer were consecutively assigned into laparoscopic group （LO, n =27） and conventional laparotomy group （CO, n=23）. Prospectively comparative analyses of operative time, intraoperative blood loss, number of lymph node harvest, positive rate of lymph nodes, length of specimen and resection margin involvement were performed. Optical microscope and scanning electron microscope were used to detect postoperative peritoneal injury between patients who received laparoscopic surgery or open surgery. Results Compared with the CO group, operative time[（150.6±39.5） min vs（183.0±39.2） min,P〈0.05] and intraoperative blood loss [（80.0±75.2） ml vs （234.5±235.3） ml, P〈0.01] were significantly less in the LO group. No significant differences were found between two groups in length specimen, number of lymph nodes harvest, positive rate of lymph nodes, and all resection margins were negative （P〉0.05）. Optical microscope indicated less serosal injury in the LO group as compared to the CO group with regard to serosal integrity, continuity of covering adipocyte and mesothelial cell, and the aggregation level of erythrocytes and inflammatory cells （P〈0.01）. Scanning electronic microscopy showed more severe injury to colorectal serosa, mesothelium and basement membrane in the CO group as compared to the LO group. Conclusion With equal degree of radical resection, laparoscopic technique for colorectal cancer causes less peritoneal structural injury as compared with open surgery.