腹腔镜与开腹直肠癌根治术临床疗效比较

Comparison of clinical effect of laparoscopic and open radical resection on rectal carcinoma

目的 评价腹腔镜手术与开腹手术治疗直肠癌的效果.方法 回顾性分析2006年1月至2012年12月北京安贞医院行直肠癌根治术235例患者的临床资料,其中132例行腹腔镜直肠癌根治术（腹腔镜组）,103例行开腹直肠癌根治术（开腹组）,比较2组患者手术时间、术中出血量、清除淋巴结数量、直肠前切除远端切缘长度、排气时间、进流质饮食时间、进固体饮食时间、留置导尿管时间、近期并发症、住院时间、住院费用及生存结果.结果 腹腔镜组与开腹组均无术中、术后严重并发症和手术死亡病例,腹腔镜组有5例中转开腹手术.腹腔镜组与开腹组手术时间分别为（258±76）和（186±18） min,差异有统计学意义（P＜0.05）;腹腔镜组术中出血量少于开腹组,分别为（144 ±22）和（320±30）ml,差异有统计学意义（P＜0.05）;腹腔镜组与开腹组淋巴结清除数分别为（12.5±2.4）和（11.5±3.4）枚,差异无统计学意义（P＞0.05）;腹腔镜组直肠前切除远端切缘长度明显长于开腹组[（3.5±0.6）em比（2.9±0.5）cm],2组间差异有统计学意义（P＜0.05）.术后胃肠道功能和排尿功能恢复时间腹腔镜组明显早于开腹组[排气时间：（2.1±0.8）d比（3.5±1.2）d;开始进流质饮食时间：（2.4±0.7）d比（3.6±0.8）d;开始进固体饮食时间：（3.5±1.2）d比（4.6±1.3）d;留置导尿管时间：（2.4±0.3）d比（4.5±1.1）d,均P＜0.05].腹腔镜组住院时间明显短于开腹组[（8.6±0.8）d比（12.7±0.9）d,P＜0.05],住院费用腹腔镜组高于开腹组,分别为（3.72±0.36）×10^4元和（2.54±0.24） ×10^4元,差异有统计学意义（P＜0.05）.术后随访腹腔镜组127例,开腹组99例,随访时间12 ～ 102个月.腹腔镜组和开腹组的1年生存率、3年生存率和5年生存率差异无统计学意义（P＞0.05）.结论 腹腔镜直肠癌根治术安全、有效,患者出血少、恢复快,根治效果达到与开腹手术相同的水平.

Objective To evaluate the therapeutic effect of laparoscopic and open radical resection on rectal carcinoma.Methods The clinical data of 235 cases of rectal carcinoma operated in in our hospital from January 2006 to December 2012 were analyzed retrospectively.Among them,132 cases underwent laparoscopic radical resection of rectal carcinoma and 103 cases underwent open radical resection of rectal carcinoma.The mean operation time,the intra-operative blood loss,the number of cleared lymph nodes,the length of distal margin of rectal anterior resection,the exsufflation time,the intake time of liquid diet,the intake time of solid diet,the duration of urethral catheterization,the short term postoperative complications,the length of hospitalization and the cost of hospitalization and the survival of the patients were compared between the two groups.Results There were no severe complications or dead cases occurring in both groups.Five cases in the laparoscopic group were converted to open during the operations.The mean operation time of laparoscopic group and open group was （258 ± 76） min and （186 ± 18） min respectively,the difference between two groups was statistically significant （P 〈 0.05）.The intra-operative blood loss of laparoscopic group was significantly less than that of open group [（144 ± 22） ml vs （320± 30）ml,P 〈 0.05].The number of cleared lymph nodes between two groups had no significant difference [（12.5 ± 2.4） vs （11.5 ± 3.4）,P 〉 0.05].The length of distal margin of rectal anterior resection in the laparoscopic group was obviously longer than that in the open group [（3.5 ± 0.6） cm vs （2.9 ± 0.5） cm,P 〈 0.05].The function recovery of gastrointestinal and urinary of laparoscopic group was more quickly than that of open group [（2.1 ± 0.8） vs （3.5 ± 1.2） d for period of exhaust ; （2.4 ± 0.7） d vs （3.6 ± 0.8） d for intake of liquid diet ;（3.5 ± 1.2） d vs （4.6 ± 1.3） d for intake of solid diet ; （2.4 ± 0.3） d vs （4.5 ± 1.1） d for duration of urethral catheterization,all P 〈 0.05].The length of hospitalization in the laparoscopic group was shorter than that in the open group [（8.6 ± 0.8） d vs （12.7 ± 0.9） d,P 〈 0.05].But the cost of hospital stay in the laparoscopic group was higher than that in the open group[（3.72 ±0.36） × 10^4 RMBs vs （2.54 ±0.24） × 10^4 RMBs,P 〈0.05].127 cases in the laparoscopic group and 99 cases in the open group received follow-up for 12-102 months.The survival rates of 1 year,3 year and 5 year between the two groups had no statistically significant （P 〉 0.05）.Conclusion The laparoscopic radical resection of rectal carcinoma is safe and effective.