腹腔镜中下段直肠癌根治手术的近期疗效及安全性分析

Evaluation of short-term efficacy and safety after laparoscopic resection for mid-low rectal cancer

目的 探讨腹腔镜中下段直肠癌手术的安全性、可行性及近期疗效.方法 2008年1月至2010年1月新疆医科大学附属肿瘤医院胃肠外科收治108例中下段直肠癌患者,按照手术方式分为腹腔镜组（63例）及开腹组（45例）进行手术；回顾性分析比较两组患者手术及术后恢复情况.结果 腹腔镜组中有7例（11.1％）中转开腹,腹腔镜组手术时间与开腹组比较差异无统计学意义[（ 246±57） min比（229±53） min,P＞0.05]；腹腔镜组平均术中出血量更少,肠道功能恢复时间更短[（51±20） ml比（110 ±41）ml,（3.0±0.8）d比（3.7±1.3）d,均P＜0.05]；在切除标本长度、肿块下缘距离及术后并发症方面,两组比较差异均无统计学意义（均P ＞0.05）；每例患者手术清扫淋巴结中位数腹腔镜组为13枚,开腹组为12枚,差异无统计学意义（P＞0.05）.两组均无切口肿瘤种植、局部复发及近期死亡病例,腹腔镜组肺转移2例,开腹组肝转移1例、肺转移1例.结论 腹腔镜中下段直肠癌根治术安全、可行、微创、根治度好,近期疗效满意,具有较好的应用前景.

Objective To investigate the safety,feasibility and short-term efficacy of laparoscopic surgery in patients with middle-low rectal cancer.Methods From January 2008 to January 2010,a total of 108 patients with middle-low rectal cancer at Department of Gastrointestinal Surgery,Affiliated Tumor Hospital,Xinjiang Medical University were divided into 2 groups by different treatments： laparoscopic resection group （ LR,n =63 ） and conventional open resection group （ OR,n =45 ）.The choice of two surgical options was based on patient＇s desire.The outcomes of two patient groups with radical surgery were prospectively evaluated.Results Seven cases were converted into open surgery from the laparoscopic group.The operative durations in the LR and OR groups were （246 ± 57 ） min and （229 ± 53） min respectively （ P 〉0.05）.The laparoscopic group had a lesser amount of blood loss during surgery （ （51 ±20） ml vs （ 110±41 ） ml,P 〈 0.05 ）.The time needed for the recovery of gastrointestinal functions in the laparoscopic group was significantly shorter than that in the open surgery group （ （ 3.0 ± 0.8 ） d vs （ 3.7 ± 1.3 ） d,P 〈0.05）.In terms of the length of specimen,the range of radical surgery and the rate of complication,no significant difference were found between two groups （ all P 〉 0.05 ）.The numbers of dissected lymph nodes were 13 and 12 cases respectively （ P 〉 0.05 ）. No instance of incision implantation,local recurrence or short-term death was found in neither group.There was 2 cases with lung metastasis in the LR group and 2 cases with the metastasis of liver and lung in the OR group.Conclusion As a safe,feasible,effective and mini-invasive with similar radical resection and satisfactory short-term outcomes,laparoscopic surgery for low-middle rectal cancer has better prospects in the future.