腹腔镜在直肠癌根治术中的应用体会

Application experience of laparoscopic radical resection of rectal cancer

目的:探讨腹腔镜直肠癌根治术的临床应用价值。方法:回顾分析2011年1月至2013年4月为112例患者行直肠癌根治术的临床资料,其中52例行腹腔镜辅助直肠癌根治术(腹腔镜组),60例行开腹手术(开腹组)。对比分析两组患者手术情况。结果:腹腔镜组1例中转开腹,51例成功完成手术;手术时间平均(150±21)min,术中出血量平均(122±45)ml,术后腹腔引流量平均(90±30)ml,术后肛门排气时间平均(2.9±0.8)d。术中无邻近脏器及输尿管损伤,术后发生切口感染脂肪液化2例,无出血、吻合口漏、排尿障碍及大便失禁等严重并发症发生及死亡病例。患者均于术后72 h内下床活动并恢复肠道功能,平均住院(9±3)d。结论:腹腔镜辅助直肠癌根治术具有患者创伤小、痛苦小、术中出血少、康复快、住院时间短、并发症少等优点,是治疗直肠癌微创、安全、有效的术式,可逐渐成为直肠癌的首选术式之一。

Objective：To evaluate the clinical value of laparoscopic radical resection of rectal cancer. Methods：The clinical data of 52 patients with rectal cancer who underwent laparoscopic-assisted radical resection （laparoscopic group） and 60 patients with routine laparotomy （ open group） from Jan. 2011 to Apr. 2013 were retrospectively analyzed. Comparative analysis of two surgical groups was done. Results：In laparoscopic group ,51 cases were successfully performed laparoscopic-assisted radical operation ,and 1 case was transferred to open operation. The average operation time was （ 150 ± 21 ） rain, the mean intraoperative blood loss was （ 122 ± 45 ） ml, the mean postoperative abdominal drainage was （90 ± 30） ml, the average anus exhaust time after operation was （2.9 ± 0.8 ） d. None of the adjacent organ or ureter was injured in operation, and there was no. postoperative bleeding, anastomotic leakage, urination dysfunc- tion or fecal incontinence, except 2 cases of incision infection and fat liquefaction. Ambulation and intestinal function all recovered with- in 72 h, and the average hospital stay was （9 ±3 ） d. Conclusions ： Laparoscopic-assisted radical resection of rectal cancer has the ad- vantages of less trauma, less pain, less intraoperative bleeding, faster recovery, shorter hospital stay, and fewer complications. As a mini- mally invasive technique, laparoscopic radical resection is safe and effective, which could gradually become one of the preferred opera- tions for rectal cancer.