腹腔镜结直肠癌根治术的可行性及近期疗效分析

The feasibility and recent therapeutic effect analysis of laparoscopic radical operation for colorectal cancer

目的:探讨腹腔镜结直肠癌根治术的可行性及近期临床疗效。方法:回顾分析2010年3月至2013年10月92例结直肠癌患者的临床资料,其中28例行腹腔镜手术,64例行传统开腹手术,对比分析两组患者术中出血量、切口总长度、肛门首次排气时间、人均止痛次数、术后下床活动时间、住院时间、手术时间、术后并发症等指标。结果:腹腔镜组术中出血量、切口总长度、肛门首次排气时间、人均止痛次数、术后下床活动时间、住院时间优于开腹组,差异有统计学意义(P<0.05)。清除淋巴结数量、术后并发症两组差异无统计学意义(P>0.05),但腹腔镜组术后并发症发生率低于开腹组,腹腔镜手术时间长于开腹手术。结论:腹腔镜结直肠癌根治术具有患者创伤小、康复快、住院时间短等优点,其手术疗效与开腹手术相当,值得临床推广应用。其适应证的掌握是循序渐进的过程,随着学习曲线的完成、技术水平的完善、手术经验的积累及腔镜设备的改进,手术适应证会逐步扩大。

Objective：To investigate the feasibility and recent clinical therapeutic effect of laparoscopic radical operation for colorectal cancer. Methods：Retrospective analysis was made on clinical data of 92 patients with colorectal cancer from Mar. 2010 to Oct. 2013,28 patients underwent laparoscopic operation,64 cases underwent traditional open operation,following factors were compared among the 2 groups：operative blood loss,incision length,first flatus time,mean analgesia times,postoperative ambulation time,hospital stay,postoperative complications and surgery time. Results：There were obvious differences in operative blood loss,incision length,first flatus time,mean analgesia times,postoperative ambulation time and hospital stay（P〈0. 05）,laparoscopic group was better than open group. There were no obvious differences in number of cleared lymph nodes and postoperative complications（P〉0. 05）,but in laparoscopic group incidence of postoperative complications was lower,and surgery time was longer than open surgery group. Conclusions：The effect of laparoscopic radical operation is similar to laparotomy in the treatment of colorectal cancer,but it has advantages of less trauma,faster recovery and shorter hospital stay. So it is worthy of extended use in clinic. Grasping of indication is step by step,along with the completion of learning curve,perfection of technique,accumulation of operative experience and improvement of laparoscopic instrument,the operative indication will gradually increase.