腹腔镜辅助与开腹直肠癌根治术近期手术疗效对比与分析

Comparison and analysis of short-term effect of laparoscopic-assisted and the laparotomy radical resection for rectal cancer

目的观察腹腔镜辅助下治疗直肠癌的手术优点、难度及适应证。方法回顾性分析43例直肠癌手术患者临床资料(腹腔镜组23例,开腹组20例),按照腹腔镜辅助直肠癌根治和开腹手术两种手术方式的不同分为两组:观察组和对照组。将两组患者的手术时间、术中出血量、清扫淋巴结总数、术后肛门排气时间、早期下床活动时间、住院时间、术后并发症发生率以及住院费用等进行比较。结果两组患者术前ASA评分、合并症、病理分级差异无统计学意义(P>0.05),腹腔镜组住院时间、术中出血量、术后肛门排气时间、下床活动时间、术后并发症发生率等均少于对照组(P<0.05)。术后随访1～24月。两组手术时间及清扫淋巴结总数比较差异无统计学意义(P>0.05)。结论腹腔镜辅助直肠癌根治具有良好的安全性和可靠性,具有出血少、创伤小,术后恢复快,住院时间短、并发症少等优势,腹腔镜技术属于在开腹手术基础上的高难度手术,在严格把握手术适应证和掌握熟练的腹腔镜技术的基础上,腹腔镜是一种很好的治疗直肠癌的先进技术,具有极广泛的应用前景。

Objective To observe the advantage, difficulty and indications of laparoscopic-assisted surgery in radical resection of rectal cancer. Methods We retrospectively analysed the clinical data of 43 patients undergoing rectal cancer surgery. The patients were divid- ed into two groups （ laparoscopic group with 23 cases, laparotomy group with 20 cases）. We contrasted the time of operation, mean bleed-ing volume, total retrieved lymph nodes, the postoperative anal exhaust time, early bed activity time, hospital stays, the incidence of com-plications and hospitalization costs. Results It was found that there was no statistical significance in ASA score before operation, compli-cation and pathological grading differences （P 〉 0.05）, and compared to laparotomy group, the hospital stays, intraoperative blood loss, the postoperative anal exhaust time, activity time and the incidence of complications decreasesd in laparoscopic group （P 〈 0.05 ）. Mean-while, postoperative follow-up was conducted for of 1 - 24 months. The total operating time and cleaning up lymph nodes were similar between the two groups （P 〉 0.05 ）. Conclusions Laparoscopic rectal-carcinoma surgery shows good safety and reliability,less bleeding and trauma, fast recovery, short hospital stays, few complications, and laparoscopic technique belongs to a complicated medical operation on the basis of open operation. Laparoscope is a kind of very good advanced technology of the treatment of rectal cancer and shows a very broad application prospects under strict grasp of the operation indication and laparoscopic technique.