腹腔镜下全直肠系膜切除术治疗低位直肠癌的疗效分析

Efficacy of Laparoscopic Total Mesorectal Excision in the Treatment of Low Rectal Cancer

目的:探讨腹腔镜下全直肠系膜切除术治疗低位直肠癌的疗效。方法:选择复旦大学附属金山医院2009年10月—2011年10月收治的低位直肠癌患者50例,在患者知情同意基础上将其分为腹腔镜组和开腹组,各25例。腹腔镜组患者行腹腔镜下全直肠系膜切除术,开腹组患者行开腹全直肠系膜切除术。比较2组患者手术时间、术中出血量、术后肛门排气时间、住院时间以及并发症发生率。结果:2组患者的保肛率均为100.0%。腹腔镜组患者术中出血量、术后肛门排气时间及住院时间分别为(24.17±5.82)mL、(37.56±6.18)h、(3.94±1.38)d,开腹组分别为(97.58±7.34)mL、(68.53±10.07)h、(5.27±1.59)d,2组间差异均有统计学意义(P<0.05);2组患者手术时间比较差异无统计学意义。腹腔镜组患者术后并发症的发生率为4.0%,明显低于开腹组的16.0%,差异有统计学意义(P<0.05)。2组患者术后随访1～12个月,均无腹壁切口的种植转移或者局部复发。结论:采用腹腔镜下全直肠系膜切除术治疗低位直肠癌临床疗效可靠,手术并发症少,安全性高,值得临床推广应用。

Objective：To investigate the efficacy of laparoscopic total mesorectal excision in the treatment of low rectal cancer. Methods：A total of 50 patients with low rectal cancer were treated in Jinshan Hospital,Fudan University from Oct 2009 to Oct 2011. They were divided into laparoscopic group and laparotomy group, with 25 patients in each group. The patients in the lapa- roscopic group underwent laparoscopic total mesorectal excision, while the patients in the laparotomy group underwent open to tal mesorectal excision. The operation time, intraoperative bleeding, postoperative anal exhaust time,postoperative hospital stay and rates of postoperative complications in the two groups were compared. Results： The sphincter preserving rates in both groups were 100%. The intraoperative bleeding volume, postoperative anal exhaust time and postoperative hospital stay of the laparotomy group were （24.17 ± 5.82）mL,（37.56 ± 6.18）h and （3.94 ± 1.38）d, respectively; they were （97.58 ± 7.34）mL, （68.53 ± 10.07）h and （5.27± 1.59）d, respectively, in the laparoscopic group. There were significant differences between the two groups（P〈0.05）. There was no significant difference in the operation time between the two groups. The postoperative complication rate was 4 % in the laparoscopie group, which was significantly lower than that of the laparotomy group（16 %） （P〈0.05）. Conclusions： The curative effect of laparoscopie total mesorectal excision in the treatment of low rectal cancer is reliable with less operation complications.