乙状结肠癌根治术手辅助腹腔镜与开腹手术围手术期疗效的对比

Comparison of short-term postoperative outcomes between hand-assisted laparoscopic and conventional sigmoidectomy

目的对比手辅助腹腔镜技术和传统开腹技术在乙状结肠癌治疗中的安全性及围手术期疗效。方法回顾性总结2009年1月至2010年6月在北京大学肿瘤医院结直肠外科施行乙状结肠癌根治性手术的115例患者的临床资料，其中手辅助腔镜（HALS组）62例，开腹组53例，对比两组手术的安全性及围手术期疗效。结果HALS组与开腹组术中清扫淋巴结总数分别为（15．1±4．6）枚和（16．8±6．4）枚（P=0．163）；两组的肿块切缘分别为（4．1±1．8）cm和（4．3±1．7）cre（P=0．601）：两组手术时间分别为（122．4±32．0）min和（126．7±37．4）min（P=0．510）。HALS组术中出血量（62．6±35．4）ml，明显少于开腹组的（168．9±137．1）ml（P=0．000）；术后围手术期并发症发生率1．6％（1／62．为肺部感染1例），明显低于开腹组的11．3％（6／53，分别为吻合口瘘1例．腹盆腔感染2例和切口感染3例）（P=0．030）；术后胃肠功能恢复快[（2．3±0．8）d比（3.3±1．1）d，P=O．000]；术后平均住院日缩短[（8．8±2．7）d比（12．6±8．0）d，P=0．001]。结论手辅助腔镜用于乙状结肠癌切除术与开腹手术相比，可达到同样的近期根治效果，并具有安全、微创的优势。

Objective To compare the safety and efficacy perioperatively between hand-assisted laparscopic surgery （HALS） and conventional open sigmoidectomy. Methods Prospectively collected data on 115 patients with sigmoid colon cancer between January 2009 to June 2010 were analyzed. There were 62 patients in the HALS group and 53 in the conventional sigmoidectomy group（CS）. Patient characteristics, operative parameters, and perioperative outcomes were compared. Results HALS patients were similar to CS patients in age（60.2 yrs vs. 63.4 yrs, P=0.163）, gender （53.2% vs. 60.4% male, P=0.441）, tumor size （4.7 cm vs. 5.3 cm, P=0.114） and tumor stage. The two groups were comparable in operative time E （122±32-0） min vs.（126.7±37.4） min, P=0.510], lymph node harvest （15.1±4.6 vs. 16.8±6.4, P=0.163）, free margin length E（4.1±1.8） em vs.（4.3±1.7） cm, P=0.601], and postoperative complications. However, HALS group had less intraoperative bleeding [（62.6± 35.4） ml vs. （168.9±137.1） ml, P=0.000], shorter time to flatus E（2.3±0.8） d vs. （3.3±1.1） d, P=0.000], and shorter hospital stay [（8.8±2.7） d vs.（12.6±8.0） d, P=-0.001]. Conclusions HALS results in similar short-term outcomes compared to conventional surgery. HALS is safe and minimally