腹腔镜辅助直肠癌根治术与传统开腹手术的临床疗效比较

Contrastive analysis of the short-term and the long-term effect of laparoscopic rectal resection and laparotomy for rectal cancer

目的探讨腹腔镜辅助直肠癌根治术对直肠癌的临床疗效。方法 2006年1月至2008年9月期间收治的直肠癌患者120例,根据手术方式不同分为腹腔镜和开腹组,每组60例。腹腔镜组患者采用腹腔镜辅助直肠癌根治术治疗,开腹组患者行传统开腹手术治疗,比较两组患者手术时间、术中出血量、排气时间、导尿管留置时间、术后住院时间以及手术前后血清CRP、IL-6水平,随访并比较两组患者1、3、5年生存率。结果腹腔镜组患者手术时间较开腹组长(P<0.05),术中出血量、术后排气时间、导尿管留置时间、术后住院时间均少于开腹组(P<0.05)。两组患者清扫淋巴结数目及并发症发生率差异无统计学意义(P>0.05)。开腹组患者术后血清CRP和IL-6水平均高于腹腔镜组(均P<0.05)。两组患者1、3、5年生存率差异无统计学意义,腹腔镜组>60岁患者的3、5年生存率高于开腹组(P<0.05)。结论腹腔镜辅助直肠癌根治术与传统开腹手术的近期和远期疗效相似,但具有手术创伤小、患者恢复快、能够保护机体免疫功能等优点,适宜在临床推广应用。

Objective To investigate the clinical effect of laparoscopic rectal resection and laparot- omy for rectal cancer. Methods 120 patients with rectal cancer admitted to our hospital from January 2006 to September 2008 were divided into the laparoscopic group and the open group （60 cases respectively）. The laparoscopic group was treated with laparoscopic radical resection, and the open group conventional open sur- gery. the operation time, intraoperative blood loss, the exhaust time, indwelling catheter time and hospital stay after the operation,and serum CRP,IL-6 levels at 1st day and 3rd day before and after the operation as well as the 1-year,3-year,5-year survival rate after operation were compared. Results The time of operation of the laparoscopic group was longer than that of the open group （ P 〈 0. 05 ） , the intraoperative blood loss, the exhaust time, indwelling catheter time and hospital stay after the operation were less than those of the open group（ P 〈 0. 05 ） ,there was no significant difference between the two groups in the number of lymph nodes excised and the complication rate（ P 〉 0.05 ） ;The serum CRP levels of the open group was higher than that of the laparoscopic group atl st day, 3rd day after operation （ P 〈 O. 05 ） , the l-year, 3-year, 5-year survival rate after operation were not significantly different between the two groups, the survival rate of patients over 60-year-old at 3-year and 5-year in the laparoseopic group was higher than that of the open group （P 〈 O. 05 ）. Conclusion There is similar effect between laparoscopic rectal resection and the conventional open surgery of short-term and long-term effect, but the laparoscopic rectal resection has a small wound, fast recov-ery and an advantage of protecting immunity, which deserve further clinical application.