低位直肠癌行腹腔镜腹会阴联合切除术临床分析

Clinical analysis of low rectal cancer underwent laparoscopic abdominal perineal resection

目的探讨腹腔镜直肠癌腹会阴联合切除术手术方法、技巧及临床应用价值。方法回顾性分析2003年7月至2010年6月30例行腹腔镜直肠癌腹会阴联合切除术(Miles术)患者(腹腔镜组)的围手术期情况,并按年龄、性别、肿块下缘距肛门距离、Dukes分期等匹配条件从同期开腹直肠癌手术(Miles术)中抽取30例(开腹组)作为参照,并对两组肿瘤手术情况、术后恢复情况、并发症发生率、随访结果等进行分析比较。结果腹腔镜组手术时间略多于开腹组,两组术中平均出血量、肠道功能恢复时间比较,差异有统计学意义(P<0.005)。两组肠段切除长度、清扫淋巴结数目、术后并发症发生率、局部复发率比较,差异无统计学意义。腹腔镜组除1例中转开腹手术外,其余29例均在腹腔镜下完成手术,手术时间平均(185±30)min,术中出血量平均(80.0±30.5)ml,术后肠蠕动恢复时间平均为(30±10)h。1例术后并发肠梗阻,1例并发造瘘口肠管缺血坏死,无死亡病例。结论低位直肠癌更加适合在腹腔镜下进行手术切除,视野暴露充分,安全可靠,出血量少,肠道功能恢复快,具备操作安全、精细,术后恢复快的优点。

Objective To evaluate the surgical methods,techniques and clinical applications of laparoscopic abdominoperineal resection（Miles operation）for low rectal cancer.Methods A retrospective analysis,30 cases of the clinical data of laparoscopic abdominoperineal resection（Miles operation）,collected from July 2003 to June 2010,30 cases from the same period in rectal cancer surgery（Miles operation） was taked as a reference group which were selected by some matching conditions such as age,gender,tumor distance from the anal lower edge,Dukes staging.Compare the two groups with tumor surgery cases,postoperative recovery,complications and follow-up results.Results The mean operation time in laparoscopic group was slightly longer than those in open group.The mean operative blood loss was（80.0 ± 30.5）ml in laparoscopic group and（150.0 ± 10.0） ml in open group（P 0.005）.No significant differences were detected between two groups in specimen length and number of lymph nodes excised（P 0.05）.The bowel function was restored much earlier in laparoscopic group than that in open group.The overall morbidity rates were 12 % and 16 %,which was no significant differences between the two groups.In this group one was converted to open radical resection,the remaining 29 cases were performed successfully in laparoscopic surgery,mean operative time was 185 minutes,the average blood loss was 80 ml,the average recovery time of bowel peristalsis was 30 h,mean postoperative hospital stay was 8 d,1 case of postoperative intestinal obstruction,1 cases made bowel ischemia complicated fistula necrosis,no deaths.Conclusions Low rectal cancer is more suitable to laparoscopic excision,those surgical field was fully exposed,which is a safe and reliable technique,and provide a better bowel function restoration and 1ess blood loss,rapid postoperative recovery advantages.