腹腔镜与开腹结肠癌根治术的近期疗效对比研究

Short-term curative effects of colon cancer radical operation

目的通过对比分析腹腔镜与开腹手术对结肠癌患者的疗效和并发症，最终确定最佳根治结肠癌的手术方法。方法回顾性分析2010年1月—2013年6月收治的72例结肠癌根治术患者的临床资料，其中行腹腔镜根治术（腹腔镜组）患者34例，开腹手术（开腹术组）患者38例，对比2组患者的术中相关指标、术后相关指标及术后并发症情况。结果腹腔镜组患者手术时间为（189．0±13．1）min长于开腹术组患者的（166．0±15．9）min（P〈0．05）；腹腔镜组患者的切口长度短于开腹术组患者（P〈0．05），其术中出血量少于开腹术组患者（P〈0．05），而淋巴结个数多于开腹术组患者（P〈0．05）；腹腔镜组患者肛门排气时间、术后肠功能恢复时间、术后镇痛时间、术后吗啡用量、术后住院天数均优于开腹术组患者（P〈0．05），但腹腔镜组患者的总住院费用略高于开腹术组患者（P〈0．05）；术后随访9～39个月，平均随访（30．1±10．7）个月，无失访病例，腹腔镜组患者术后粘连性肠梗阻发生率为5．8％（2／34），显著性低于开腹术组患者的23．7％（9／38）（P〈0．05）；腹腔镜组患者切口感染发生率为5．8％（2／34），显著性低于开腹术组患者的26．3％（10／38）（P〈0．05）；吻合口瘘、吻合口出血、肺部感染2组相比差异无统计学意义（P〉0．05）；腹腔镜组患者术后并发症总发生率为32．4％（11／34），显著性低于开腹术组患者的63．2％（24／38）（P〈0．05）。结论与开腹手术相比腹腔镜辅助结肠癌根治术虽然手术时间相对较长且价格相对较昂贵，但术中出血少，且术后康复迅速，并发症发生率低，所以临床上应结合患者的病情和经济情况选择合适术式。

Objective Through comparing the curative effects and complications of using laparoscopy or laparotomy for the treatment of colon cancer to find the better surgery method. Methods From January 2010 to June 2013 in our hospital, clinical data of 72 patients with colon cancer were chosen and retrospective analyzed; there were 34 cases of patients using laparoscopy while 38 cases having laparotomy;intraoperative related indicators, related indicators after surgery and postoperative complications of the two groups were carefully compared. Results Although the surgical time of the laparos- copy group was（ 189.0 ± 13.1 ） min which was significantly longer than that of the laparotomy group（ 166.0 ± 15.9） min （ P 〈 0.05 ） in patients with laparoscopic group of patients （ P 〈 0.05 ）, the length of incision, intraoperative bleeding and the number of lymph nodes cleared in the laparoscopy group were better than those of the laparotomy patients （ P 〈 0.05 ） , as well as the anus exhausting time, postoperative intestinal function recovery time, postoperative pain time and postoperative morphine consumption and postoperative hospitalization clays （ P 〈 0.05 ） , but the total cost of hospitalization in patients using laparoscopy was slightly higher than that of the laparotomy group （P 〈 0.05 ） ;all patients were followed-up for 9 - 39 months, （ 30.1 ± 10.7 ） months on average, and none of the patients were lost to follow-up ; the incidence of postop- erative adhesive intestinal obstruction in patients having laparoscopy was 5.8% （2/34） ,which was significantly less than that of the laparotomy group 23.7% （9/38） ,P 〈0.05, as well as the incision infection rate of the laparoscopy group was 5.8% （2/34） which was less than the laparotomy group＇ s 26.3% （ 10/38 ） , P 〈 0.05 ;there were no statistical signifi- cance（ P 〉 0.05 ） in terms of anastomotic fistula,anastomotic bleeding and lung infection compared between two groups; the total incidence of postoperative complications in patients having laparoscopy was 32.4% （11/34 ） , which was signifi- cantly less than that of the laparotomy group 63.2% （ 24/38 ） ,P 〈 0.05. Conclusion Although compared with laparoto- my, the surgical time and cost of colon cancer radical surgery assisted with laparoscopy was relatively longer and more, there were some advantages such as less bleeding, and faster postoperative recovery and lower complication rates ; so appropriate operation should be chosen according to the patients＇ clinical conditions and economic conditions.