腹腔镜与开腹经括约肌间超低位直肠癌保肛手术的临床对照研究

Laparoscopic versus open intersphincteric resection for low rectal cancer： a clinical comparative study

目的比较腹腔镜与开腹经括约肌间切除术（ISR）治疗超低位直肠癌的安全性、可行性及临床疗效。方法回顾性分析2007年1月至2010年1月间在川北医学院附属医院接受腹腔镜ISR手术的27例超低位直肠癌患者（腹腔镜组）的临床资料，并选取同期行开腹ISR手术的41例超低位直肠癌患者作为对照（开腹组）。比较两组患者的手术指标、术后并发症、肿瘤相关指标、术后肛门功能及预后。结果腹腔镜组均顺利完成ISR手术，无一例中转开腹。与开腹组相比，腹腔镜组手术时间明显延长[（242．2±42．5）min比（199．1±44．3）min，P=0．000]，术中出血量明显减少[（150．5±102．2）ml比（258．4±149．2）ml，P=0．002]，术后肛门排气时间[（2．9±1．1）d比（3．6±1．5）d，P=-0．032]和恢复正常饮食时间[（6．6±1．2）d比（7．5±1．7）d，P=0．012]及术后住院时间[（7．7±1．4）d比（9．1±2．4）d，P=0．006]均明显缩短。腹腔镜组与开腹组淋巴结清扫数量[（14．1±4．1）枚比（16．4±6．8）枚，P=0．113]、远切缘长度[（1．4±0．7）cm比（1．6±0．8）cm，P=0-311]及环周切缘阳性率[7．4％（2／27）比2．4％（1／41），P=0．709]方面的差异均无统计学意义。两组术后并发症发生率、术后局部复发率、远处转移率及术后肛门功能的差异均无统计学意义（19〉0．05）。结论腹腔镜ISR手术治疗超低位直肠癌术中出血少、术后恢复快，可取得与开腹手术相似的肿瘤根治效果，安全可行。

Objective To compare the clinical and oncological outcomes between laparoscopic and open intersphincteric resection in patients with low rectal cancer. Methods From January 2007 to January 2010, patients with low rectal cancer treated by laparoscopic or open intersphincteric resection were included in a retrospective comparative study. Patients were classified into laparoscopy group （n= 27） and open group （n=41）. The operative procedures, postoperative complications, anal function and clinicopathological data were compared. Results Compared to the open group, the laparoscopic group had longer operative time[ （242.2±42.5） min vs. （199.1±44.3） min, P=0.000], less blood loss [ （150.5± 102.2） ml vs. （258.4±149.2） ml, P=0.002], faster recovery of bowel funetion[（2.9±1.1） d vs. （3.6± 1.5） d, P=0.032] and resumption of regular diet[（6.6±1.2） d vs. [（7.5±1.7） d, P=0.012], and shorter postoperative hospital stay [（7.7±1.4） d vs. （9.1±2.4） d, P=0.006]. The postoperative complication rate between the laparoscopic and open groups was not significantly different [ 18.5%（5/27） vs. 19.5% （8/41）, P=0.464]. Oncologieal parameters were comparable between the two groups including lymph node harvested [（14.1±4.1） vs. （16.4±6.8）, P=0.113], distal resection margin [（1.4±0.7） cm vs. （1.6±0.8） cm, P=0.311], and circumferential margin [7.4%（2/27） vs. 2.4%（1/41）, P=0.709].Local recurrence rates in laparoscopic and open groups were 7.4% （2/27） and 2.4% （1/41）, and distant metastasis rates were 0 and 4.9% （2/41） respectively, and the differences were not significant （both P〉0.05）. Conclusions Laparoscopic intersphincteric resection possesses same efficacy of open intersphincteric resection with less blood loss, shorter recovery time and hospital stay, and similar oncological outcomes, and no increased postoperative morbidity and mortality.