腹腔镜与开腹直肠癌根治术临床疗效的对比研究

Comparison of laparoscopic and open radical resection for rectal cancer

目的比较腹腔镜与开腹直肠癌根治术的远期和近期临床疗效。方法2004年6月至2009年8月由同一手术组完成腹腔镜直肠癌根治术312例及开腹直肠癌根治术226例，分析比较两组患者的远期生存率、手术情况、术后恢复情况及术后并发症。采用Lifetable分析法对资料进行生存分析，Gehan法对生存曲线进行显著性检验。结果两组患者在年龄、性别、肿瘤分期和肿瘤病理分型等方面无明显差异。术后3、5年生存率腹腔镜组分别是84．5％和66．7％；开腹组分别是83．3％和64．8％，两组患者术后生存率经Lifetable生存分析无明显差异。腹腔镜组和开腹组的出血量分别为61±13ml和174±84ml（t=23．24，P〈0．05）、术后排气时间分别为2．7±1．3d和3．64-1．8d（t=6．61，P〈0．05）、术后住院日分别为9．1±2．4d和12．0±3．4d（t=11．8，P〈0．05）。腹腔镜组与开腹组淋巴结清扫数分别为11．0±2．7枚和12．0±3．6枚（t=1．72，P〉0．05），直肠标本长度分别为16．0±3．4em和16．04-4．3elTI（t=0，P〉0．05），直肠肿瘤远端切缘分别为3．2±1．3em和3．2±1．7cm（t=0，P〉0．05），开腹组术后切口感染28例，腹腔镜组8例（P〈0．05），两组患者术后其他并发症发生率无统计学差异。结论腹腔镜直肠癌根治术远期疗效与开腹手术相似，且具有创伤小、术后恢复快、并发症少等优势。

Objective To compare the results of laparoscopic and open radical operation for rectal cancer. Methods Three hundred and twelve patients with laparoscopic operation and 226 cases with open operation during the period of June 2004 to August 2009 were included. The long-term survival, operative data,postoperative recovery and complications were compared between the two grougs. Results There were no significant differences in age, sex, tumor stage and histologic types between the two groups. The 3 and 5- year-survival rate was 84. 5% and 66. 7% in laparoscopie group ,83.3% and 64. 8% in traditional operation group with no significant difference by Life-table method. The intraoperative blood loss in laparoscopic group was obviously less than that in open group （61± 13 ml vs 174 ±84 ml,t =23.24,P 〈0. 05）. The time of passage of gas by anus and hospital stay in laparoscopic group were significantly shorter than those in open group （2.7±1.3 d vs 3.6 ±1.8 d,t=6. 61,P〈0.05;9. 1 ±2.4d vs 12.0±3.4 d, t =11.8,P〈0.05）. No significant difference was observed between the two groups in the lymph nodes clearance （ 11.0± 2. 7 vs 12 ± 3.6, t = 1.72 ,P 〉 0. 05 ）, specimen length （ 16. 0 ±3.4 cm vs 16. 0 ±4. 3 cm, t = 0, P 〉 0. 05 ） and distal margin （3.2±1.3 cm vs 3.2± 1.7 cm, t =O,P 〉0. 05）. Surgical site infection of incision developed in 28 cases in open surgery group and in 8 cases in laparoscopic group （P 〈 0.05 ）. Conclusions Laparoscopic surgery for rectal cancer can achieve similar long-term survival as conventional laparotomy with minimal invasion, quicker recovery and less complications.