腹腔镜与开腹中低位直肠癌保肛术后肛门功能临床对比研究

Comparison of anal function following laparoscopic or open surgery for patients with middle and lower rectal cancer

目的 探讨腹腔镜和开腹中低位直肠癌前切除术对肛门功能的影响.方法 选择2009年6月至2011年1月间行中低位直肠癌前切除术109例直肠癌患者作为研究对象.根据手术方式,将患者分为腹腔镜组和传统开腹组,其中腹腔镜组59例,传统开腹组 50例.分析两组患者的临床资料,比较两组患者术后肛门功能的差异.结果 术后3、6、12个月腹腔镜组和开腹组肛门功能的优良率分别是78.0%和76.0%、84.7%和88.0%、98.3%和96.0%,两组相比均无明显差异（均P ＞0.05）.术后3、6、12个月两组患者肛门测压结果相比也基本相似,均没有发现明显统计学差异（均P ＞0.05）.与开腹手术相比,腹腔镜组术中出血量较少,术后排气时间较早,术后住院时间较短,术后切口感染腹腔镜组少于开腹组,但手术时间腹腔镜组略长于开腹组（P＜0.05或0.01）.结论 腹腔镜手术与传统开腹手术对患者术后肛门功能的影响相当,但具有明显的微创优势.

Objective To compare the anal function following laparoscopic or open surgery for patients with middle and lower rectal cancer. Methods One hundred and nine patients with middle and lower rectal cancer underwent surgery during June 2009 to January 2011, including 59 cases received laparoscopic operation （laparoscopic group） and 50 cases received tra- ditional open operation （open group）. The clinical data of the patients were retrospectively analyzed and the anal function was compared between two groups. Results No significant differences were found in age,sex,tumor stage and histological types between two groups. The excellent rates of postoperative anal function in laparoscopic group and open group were 78.0% vs 76.0% at 3th month,84.7% vs 88.0% at 6th month and 98.3% vs 96.0% at 12th month （P 〉0.05）. There was no significant differ- ence in anorectal manometry results between two groups. The intraoperative blood loss in laparoscopic group was significantly less than that in open group （60±17.9 vs 187±38.6 ml,P〈0.05）. The time of passage of gas and hospital stay in laparoscopic group were significantly shorter than those in open group （2.5±3.6 vs 3.9±3.7d, 9.0±3.1 vs 13.9 ±5. ld, respectively, P〈0.05）. However,the operating time for laparoscopic operation was longer （196±26.5 vs 162 ±29.1 min,P 〈0.05）. Conclusion Laparoscopic surgery for middle and lower rectal cancer can achieve the same anal function as traditional open operation. And laparoscopic operation can also offer patients with advantages of minimally invasiveness.