腹腔镜直肠癌切除术近远期疗效分析

The analysis of short-term and long-term treatment outcomes of laparoscopic resection for rectal cancer

目的:分析腹腔镜直肠癌切除术的近、远期疗效。方法:回顾分析2001年9月至2007年9月139例腹腔镜直肠癌切除术患者5年以上随访的临床资料。结果:围手术期死亡1例,中转开腹3例;手术时间平均(159.9±45.2)min,术中出血量平均(72.6±54.7)ml。术后吻合口漏4例,直肠阴道瘘1例,会阴部切口感染2例,尿潴留5例,造口旁疝3例,切口孔疝1例,粘连性肠梗阻3例。中位随访75个月,无切口种植,局部复发9例,远处转移26例,死亡36例,累积5年总生存率75.8%。结论:腹腔镜直肠癌切除术的近、远期疗效与开腹手术相当,更有利于行全直肠系膜切除,具有患者创伤小、出血少、康复快、切口并发症少等优点。

Objective：To analyze the short-term and long-term treatment outcomes of laparoscopic resection for rectal cancer. Methods：From Sep. 2001 to Sep. 2007,139 patients with rectal cancer underwent laparoscopic resection. The patients were followed up for more than 5 years and their follow-up data were retrospectively reviewed. Results：There was one death during perioperative period. 3 patients were converted to open procedure. The average operating time was （ 159.9 _＋ 45.2 ） min and the average blood loss was （72.6 ＋ 54.7 ） ml. Postoperative complications included anastomotic leakage in 4 cases, recto-vaginal fistula in 1 patient, perineal wound infection in 2 cases,5 cases of urinary retention, parastomal hernia in 3 patients, 1 Trocar site hernia and 3 adhesive bowel ob- structions. The median time of foUow-up was 75 months （range,3-132）. No port-site implantation occurred,but 9 patients had local re- currence and 26 patients had distant metastasis. 36 patients were dead. Overall survival rate of 5-years was 75.8%. Conclusions：The short-term and long-term treatment outcome of laparoseopic resection for rectal cancer is not inferior to open surgery.