腹腔镜保肛全直肠系膜切除术治疗直肠癌的临床分析

Laparoscopic sphincter preserving total mesorectal excision for rectal cancer： clinical analysis of 30 cases

目的 探讨腹腔镜保肛全直肠系膜切除术治疗直肠癌的手术方法及近期疗效.方法 回顾性分析2010年6月至2013年1月间30例直肠癌患者行腹腔镜保肛全直肠系膜切除术（腹腔镜组）,与同期32例直肠癌行开腹直肠前切除术（开腹组）作对照.结果 腹腔镜组术中失血（151.8±19.2）ml,明显少于开腹组（236.5±43.9） ml,P=0.000;手术时间腹腔镜组为（236.7±16.2）min,长于开腹组的（195.9±10.9）min,P=0.000;腹腔镜组肠道功能恢复为（2.4±0.6）d,早于开腹组的（2.9±0.5）d,P=0.001;且住院时间短（P=0.000）;腹腔镜组总并发症发生率低于开腹组[6.7％（2/30）、31.3％（10/32）,P=0.014,腹腔镜组吻合口漏1例、肠梗阻1例,开腹组吻合口漏2例、肠梗阻3例,开腹组切口感染2例、切口裂开和切口疝各1例,术后发生肺不张1例;腹腔镜组清扫淋巴结数目为（11.95±1.73）枚,开腹组为（11.65±1.40）枚（P=0.465）;肿瘤距下切缘距离腹腔镜组为（4.46±1.19） cm,开腹组为（4.58±0.68） cm（P=0.647）;下切缘阴性率均为100％,术后病理分期及生存时间两组间差异均无统计学意义（P＞0.05）,但腹腔镜组住院费用仍较高（P＜0.01）.结论 腹腔镜保肛全直肠系膜切除术治疗直肠癌创伤小、出血少、恢复快、并发症发生率低,根治效果与开腹术一样彻底,但住院费用高于开腹组,手术时间在学习曲线内长于开腹组.

Objective Laparoscopic sphincter preserving total mesorectal excision for short-term effect in the treatment of rectal cancer.Methods A retrospective analysis from 2010 June to 2013 Jan uary,30 patients with rectal cancer underwent laparoscopic sphincter preserving total mesorectal exci sion （laparoscopic group）,With the same period in 32 patients with rectal cancer underwent anterior resection of rectum （open group） as control.Results Blood loss during laparoscopic group（151.8 ±19.2） ml was significantly less than the open group（236.5 ± 43.9） ml,P=0.000.Operation time of laparoscopic group （236.7 ± 16.2） min is longer than the open group（195.9 ± 10.9） min,P=0.000.Recovery of intestinal function in laparoscopic group（2.4 ± 0.6） d early in the open group（2.9 ± 0.5）d,P=0.001.And short hospitalization time （P=0.000）.The total complication rate was lower than the open group[6.7%（2/30）、31.3%（10/32）] （P=0.014）.Laparoscopic group one case of anasto motic leak,One case of intestinal obstruction,Laparotomy group anastomotic 2 cases of leakage,3 cases of intestinal obstruction,wound infection in 2 cases,Wound dehiscence 1 case and incisional hernia in 1case,Atelectasis one case.Laparoscopic group lymph node dissection number（11.95 ± 1.73）,Open group（11.65 ± 1.40） （P=0.465）,distance from tumor to the lower incision margine（P=0.647）.Un der negative margin rate was 100%,Pathological staging and no significant difference in survival time （P〉0.05）;But laparoscopic group hospitalization costs still high（P〈0.01）.Conclusions Laparo scopic sphincter preserving total mesorectal excision for rectal cancer is not only less trauma,less bleeding,rapid recovery,and low complication rate,And the two group of radical effect is the same as thoroughly.But hospital costs higher than the laparotomy group,Longer than open surgery group in the learning curve.