腹腔镜低位直肠癌保肛手术与传统开腹手术的疗效对比分析

Comparison of laparoscopic and open anterior resection for rectal cancer with anal sphincter preservation

目的探讨腹腔镜低位直肠癌保肛手术的可行性、安全性、经济性及近期疗效。方法回顾性对比分析2007年12月～2010年11月开展的低位直肠癌保肛手术52例,其中腹腔镜直肠癌全系膜切除的病例28例(腹腔镜组),开腹直肠癌全系膜切除的病例24例(开腹组),对其资料及医疗成本进行比较分析。结果腹腔镜组与开腹组的一般资料差异无显著性。腹腔镜组术中出血量、手术切口长度、恢复肠道功能的时间、下床活动时间和住院时间([65±52)mL、(5.0±1.4)cm、(36±12)h、(4.2±1.1)d和(11.6±3.2)d]明显低于开腹手术组([168±63)mL、(19.1±4.5)cm、(77±18)h、(8.2±3.1)d和(18.2±4.7)d](P<0.05)。两组清扫淋巴结的数目差异无显著性,下切缘均为阴性(P>0.05)。开腹手术组术后切口感染发生机会多于腹腔镜组(P<0.05),两组吻合口瘘的发生率基本相同。总住院费用差异无显著性(P>0.05)。结论腹腔镜低位直肠癌保肛手术创伤小,恢复快,安全可靠,能够取得与开腹手术同样的肿瘤根治性效果,且不增加总的医疗成本。

[Objective] To evaluate the feasibility,safety and advantage of laparoscopic anterior resection for rectal cancer with anal sphincter preservation.[Methods] From Dec.2007 to Nov.2010,28 patients with rectal cancer underwent anterior resection,while 24 cases were subjected to open procedure.The early outcomes as well as the medical costs of two groups were compared.[Results] The mean operative blood loss,the length of incision,the resuming time of bowel function,the time of resuming early activity and the hospital stay [（65±52） mL,（5.0±1.4） cm,（36±12） h,（4.2±1.1） d and（11.6±3.2） d] in laparoscopic group were significantly lower than that [（168±63） mL,（19.1±4.5） cm,（77±18） h,（8.2±3.1） d and（18.2±4.7） d] in open group（P 0.05）.No significant differences were detected between two groups in specimen length and lymph node harvest（P 0.05）.Vesical hematuria and infection in incision are more likely to take place in open group than in laparoscopic group.The rate of anastomotic leakage was almost same in two groups.The total medical cost was not significantly different between two groups.[Conclusions] Laparoscopic surgery is feasible,safe and minimally invasive technique for rectal cancer with anal sphincter preservation,which can get the same radical effect of TME compared with the traditional open procedure.The total economical burden for the patients were not significantly different between the laparoscopic and open groups.