腹腔镜与开腹结直肠癌切除术肿瘤学与形态学根治性评价

Comparative study on oncologic outcomes and Laparoscopic morphology evaluation of laparoscopic versus conventional radical resection for rectal carcinoma

目的评价腹腔镜和同期开腹直肠癌根治术在肿瘤学结果的差异;观察腹腔镜形态学下结直肠解剖标志及关键血管区域淋巴清扫程度。方法连续地将符合纳入研究标准的50例结直肠癌患者分别进入腹腔镜组(LO组,27例)和开腹组(CO组,23例),前瞻性比较两组患者肿瘤学结果;观察腹腔镜形态学下解剖标志及血管区骨骼化,评价区域淋巴清扫效果。结果 LO组平均手术时间略短于CO组但差异无统计学意义,LO组术中失血量显著少于CO组;两组外科肿瘤学结果比较均差异无统计学意义(P>0.05),标本切缘均阴性;腹腔镜形态下特殊恒定的解剖标志利于选择合适的解剖学平面及融合筋膜间隙进行游离从而实施可靠、安全的完整肿块切除、血管骨骼化及关键区域淋巴结清扫;腹腔镜组患者术后与开腹组相比,术后前3天内腹腔引流量差异无统计学意义(P>0.05),术后功能恢复指标及总住院时间均显著减少(P<0.05)。结论与传统开腹手术相比,腹腔镜结直肠手术安全、可行,达到同等肿瘤学根治效果;腹腔镜形态学下观察发现肿块切除完整,血管解剖结构清晰,区域淋巴清扫满意;平均手术时间短,失血量少,机体功能恢复快,总住院时间短。

Objective To compare oncologic results and postoperative recovery between laparoscopic and open approach for rectal cancer; To evaluate surgical effective outcomes by the anatomical landmarks, vascular skeletonization and regional lymph node dissection in laparoscopic morphology. Methods A total of 50 patients with colorectal cancer were consecutively assigned into laparoscopic group （LO,27 cases） and conventional group （CO,23 cases）. The relevant indicators of surgical oncology and postoperative recovery were prospectively compared between groups. Results Compared with CO group, operating time and intraoperative blood loss were decreased significantly in LO group. No significant differences were found between the two groups in terms of length specimen, number of lymph nodes removed, and width of distant resection margins which were all neghtive in the study. On laparoscopic morphology, tumor excision, vascular skeletonization, regional lymph node dissection were achieved laparoscopically through anatomical spaces in laparoscopic group. LO group were shorter than CO group in stomach tube retention, catheter retention, exhaust time, liquid food, body temperature recovery, and hospital stay. Conclusion Compared with conventional operation, laparoscopic colorectal surgery is safe and feasible with equal oncologic outcomes; tumor excision, vascular skeletonization and regional lymph node dissection were achieved laparoscopically through anatomical spaces; In addition, shorter operative time, less blood loss and faster recovery.