手助腹腔镜结直肠癌根治手术的短期临床效果分析

Hand-assisted laparoscopic radical surgery for colorectal cancer:a short-term clinical effect analysis

目的:探讨手助腹腔镜(hand-assisted laparoscopic surgery,HALS)结直肠癌根治术的短期临床效果,并与开腹手术、传统腹腔镜手术(laparoscopic-assisted surgery,LAS)进行对比。方法:将2010年1月至2011年5月收治的结直肠癌患者随机分为HALS组(n=40)、LAS组(n=47)及常规开腹组(n=25),对比3组患者短期临床效果。结果:HALS组中3例中转开腹,1例因肿瘤大且盆腔狭窄,2例因肿瘤局部侵犯较严重;LAS组中2例因肿瘤较晚中转开腹;余均顺利完成手术。手术时间HALS组较LAS组短、较开腹组稍长。切口长度HALS组较LAS组长、较开腹组短。HALS组与LAS组相比,术中失血量、住院时间、术后排气时间、淋巴结清扫数量差异均无统计学意义(P>0.05)。HALS组较开腹组术中失血量、术后排气时间、住院时间均明显减少(P<0.05),但两组淋巴结清扫数量差异无统计学意义(P>0.05)。结论:HALS与LAS结直肠癌根治术较开腹手术均具有安全可行、创伤小、康复快、住院时间短等优点,HALS较LAS操作难度低,更适合初学者。

Objective：To study the short-term clinical effects of radical operation of colorectal cancer among hand-assisted laparoscopic surgery（HALS）,laparoscopic-assisted surgery（LAS） and traditional open surgery.Methods：Patients with colorectal carcinoma from Jan.2010 to May 2011 were randomly divided into HALS group（n=40）,LAS group（n=47） and open group（n=25）.The short-term clinical effects of above groups were comparatively analyzed.Results：Three cases in HALS group were converted to open surgery,the reasons included huge tumor and narrow pelvic cavity（n=1） and serious local invasion of tumor（n=2）.2 cases in LAS group were converted to laparotomy for late stage.All the other operations were successfully accomplished.The mean operation time of HALS group was shorter than LAS group,but longer than open group.Incision length in HALS group was longer compared with LAS group,but significantly shorter than open group.The mean intraoperative blood loss,lymph node harvests,postoperative flatus time and hospital stay were not different between HALS group and LAS group.But in HALS group the above indicators were better than those in open group except lymph node harvests.Conclusions：For radical resection of colorectal cancer,HALS and LAS have the similar advantages,such as safety,feasibility,mini-invasion,rapid recovery,short hospital stay and so on.HALS is easier and more suitable for beginner practitioners of laparoscopic surgery.