直肠癌腹腔镜手术的临床分析(附169例报告)

Clinical analysis of laparoscopic surgery for rectal cancer:with a report of 169 cases

目的:探讨直肠癌腹腔镜手术的应用价值及可行性。方法:为符合纳入标准的169例直肠癌患者施行腹腔镜直肠癌根治术,观察手术特征数据、近期疗效、安全性及远期疗效等,并进行统计分析。结果:169例直肠癌腹腔镜手术中Dixon术85例,Miles术83例,Hartmann手术1例。1例中转开腹。手术时间平均138min,术中4例(2.4%)输血;平均清扫淋巴结7枚,切除标本长度平均19cm;术后首次下床活动时间3.50d,术后首次排气时间2.96d,术后首次排便时间3.90d,术后首次进流食时间5.71d;术后感染14例(8.3%),吻合口漏4例(2.4%),肠梗阻1例(0.6%);中位随访48.2个月,1年、3年、5年生存率分别为92.2%、73.5%、64.1%,5年复发转移率32.5%,无切口及穿刺孔种植转移。结论:直肠癌腹腔镜手术安全可行,可推广应用。

Objective：To study the value and feasibility of laparoscopic surgery in rectal cancer. Methods ：169 patients with rectal cancer who met the inclusive criteria were selected to perform laparoscopic radical surgery. The operation data, short-term effectiveness,safety and long-term therapeutic effect were observed and statistically analyzed. Results ： 169 patients with rectal cancer were performed laparoscopic surgery. In these patients,85 patients were operated in Dixon style ,83 patients in Miles ,and I patient in Hartmann. 1 patient was converted to open surgery. Mean operative time was 138 min,the percentage of patients who needed blood transfusion was 2.4% （4 cases）. The mean number of harvested lymph nodes was 7 ,amt length of specimen was 19 em. The time to postoperative off-bed activity, first exhaust, defecation and fluid intake were 3.50 d,2.96 d,3.90 d and 5.71 d respectively. The incidences of infectious emnplieations,anastomotic leakage, and intestinal obstruction were 8.3% （ 14 cases）, 2.4% （4 cases） and 0.6% （ 1 case） , respectively. The median follow-up was 48.2 months. The rate of 1 -year survival, 3-year survival,5-year sruvival, and rate of 5- year recurrence were 92.2% ,73.5% ,64.1% and 32.5%. No port site or wound metastasis was found till now. Conclusions ：The laparoscopic surgery for reetal cancer is safe and effective and should be recommended in clinic.