直肠癌腹腔镜下TME术与传统开腹TME术术后短期效果观察

Short-term effect observation between laparoscopic and open TME rectomy

目的比较直肠癌腹腔镜下TME术与传统开腹TME术围手术期相关指标及病理数据,分析2种术式特点及术后短期效果差异。方法对76例行腹腔镜下TME术的直肠癌患者与62例行开腹TME术直肠癌患者进行回顾性队列研究的资料采集,采集包括手术时间、麻醉时间、失血量、术中输血、手术切口长度、切口感染、其他并发症、术后住院时间及院内病死率在内的反映手术短期效果的数据,同时采集反映肿瘤大小、检获淋巴结数目、肿瘤距远端或近端切缘的距离以及切缘肿瘤阳性率在内的组织病理学数据;采用回顾性队列研究的研究方法,统计分析2种术式在上述各个方面的数据特点,探讨两者在围手术期各个具体指标上的差异性。结果开腹组在手术时间、麻醉时间等项目上较腹腔镜组而言并不具有明显的优势;而腹腔镜组在术后恢复指标上,如术后镇痛药使用、术后肛门恢复排气时间、术后恢复进食时间及术后住院时间等方面,占有明显的优势,且这样的优势具有统计学意义。结论腹腔镜TME术式在术后镇痛药使用、胃肠功能恢复及住院时间等指标上较传统开腹术式仍具有优势。

Objective To analyse the different characteristics and short-term effect by comparing peri-operative relat-ed index and pathological data between laparoscopic and traditional open TNE rectomy. Methods 76 cases of patients under-went laparoscopic TNE rectomy and 62 of patients underwent open TNE rectomy were enrolled as treatment group and control group respectively,and retrospective cohort study was applied to analyze. Following indexes were collected：to reflect the effect of short-term operation data such as length of surgery,length of anesthesia,loss of blood,intro-operation transfusion,length of incision wound,incision infection,other complication,hospitalization time after operation and fatality rate in hospital;and pathohistologic data were collected including in tumor size,number of lymph nodes,the distance from the distal or proximal re-section margin of the tumor and positive rate of resection margin. Retrospective cohort study was adopted to analyse the charac-teristics of collected data in each aspects mentioned above respectively,and differences of peri-operation indexes were dis-cussed. Results Compared to the traditional open group,the laparoscopic group had no significant advantages in the length of surgery and anesthesia,while the laparoscopic group had significant advantages in post-operative recovery index,including less use of analgesic,earlier recovery of fart and diet and shorter length of post-operative stay,which was statistically significant. Conclusion Laparoscopic TNE has advantages in post-operative analgesic adoption,recovery of gastrointestinal function and post-operative stay Compared to the traditional open surgery.