腹腔镜和开腹全直肠系膜切除术治疗直肠癌的对比研究

Comparison of laparoscopic and open total mesorectal excision for rectal cancer

目的评估腹腔镜和开腹全直肠系膜切除手术治疗直肠癌的优劣性,探讨腹腔镜全直肠系膜切除术治疗直肠癌的可行性和安全性。方法将采用全直肠系膜切除术治疗的136例直肠癌患者分为观察组和对照组各68例,观察组在腹腔镜下操作,对照组采用传统开腹手术,比较两组的手术学指标、术后并发症、局部复发率和远处转移率。结果所有患者均顺利完成手术,无术中死亡病例。观察组的手术时间、术中出血量及住院时间均少于对照组,两组比较差异有统计学意义(P<0.05),观察组发生吻合口漏2例(2.94%),对照组发生吻合口漏6例(8.82%),两组比较差异有统计学意义(P<0.05),所有患者均获随访6个月～2年,观察组局部复发6例,远处转移8例,2年生存率为85.29%;对照组局部复发8例,远处转移6例,2年生存率为79.41%;两组近期疗效比较差异无统计学意义(P>0.05)。结论腹腔镜全直肠系膜切除术治疗直肠癌,不但可以达到与传统开腹手术相同的近期疗效,而且具有手术时间短、术中出血少、术后疼痛轻、肠功能恢复快,住院时间短等优点,值得临床推广。

Objective To evaluate the advantage and disadvantage of the treatment of laparoscopic and open total mesorectal excision for rectal cancer, also to investigate the safety and feasibility of laparoscopic total mesorectal exci- sion （TME） in the treatment of rectal cancer. M^ods One hundred and thirty-six cases who needed total mesorectal excision for rectal cancer were divided into two groups with observation group and control group, 68 cases in each group. Patients in observation group were implemented with laparoscopic method, yet patients in control group were implemented by normal open abdomen surgery. Operative indicator, postoperative complications, the rate of local re- currence and distant metastasic between two groups were compared, Results One hundred and thirty-six cases were all performed successfully with no dead case. Operation time and blood loss in observation group were less than that of control group, and there were significc^nt differences between two groups （P ~ 0,05）, 2 cases had anastomotic leakage in observation group （2.94%）, while 6 case had anastomotic leakage in control group （8,82%）, there were significant dif- ferences between two groups （P 〈 0.05）. 136 cases received follow-up from 6 months to 2 years, and there were 6 cas- es of local recurrence and 8 cases of distant metastasis in observation group, and the 2-year survival rate were 85.29%. There were 8 cases of local recurrence and 6 cases of distant metastasis in control grous, and the 2-year sur- vival rate were 79.41%, and there was no significant differences between two groups （P 〉 0.05）. Conclusion The la- paroscopic total mesorectal excision for rectal cancer got same short-term effect with normal open abdomen surgery, b/ut the operation time is shorter, intraoperative blood loss is less than normal open surgery, the postoperative pain is slightly, and the recovery of the intestines function is shorter, so it is worthy to be widely used in clinical treatment.