开腹与腹腔镜全直肠系膜切除术治疗直肠癌的对比分析

Comparative study about laparotomy and laparoscopic total mesorectaI excision for rectal cancer

目的探讨腹腔镜全直肠系膜切除根治术(TME)的安全性及临床效果。方法将98例直肠癌患者分为开腹组(51例)例和腹腔镜组(47例)例进行全直肠系膜切除根治术,并对其临床效果进行对比分析。结果开腹组和腹腔镜组手术均顺利完成,2组平均手术时间无显著性差异(P>0.05);2组清扫淋巴结数量无显著性差异(P>0.05);2组手术并发症发生率无显著性差异(P>0.05)。开腹组手术出血量多于腹腔镜组(P<0.05);肠道功能恢复时间晚于腹腔镜组(P<0.05);术后下床活动时间晚于腹腔镜组(P<0.05);住院时间长于腹腔镜组(P<0.05)。结论腹腔镜TME根治术具有手术视野清、创伤小等优点,术后可早期下床活动,住院时间短,符合目前微创外科新技术发展趋势,该手术方式已逐步发展成熟,有望成为结直肠癌手术治疗标准,值得临床推广使用。

Objective To investigate the safety and clinical effect of rectal cancer treated by Laparoscopic total mesorectaI excision（ TME）. Methods A series of 98 rectal cancer patients were divided into Laparotomy TME group（51cases）and Iaparoscopic TME group（47 cases）,and compare their clinical results analysis. Results Laparotomy group and laparoscopic group surgery were successfully completed. The mean operative time of two groups no significant difference（P 〉0. 05）;Two surgical complication rate of two groups no significant difference（P〉 0. 05）;The number of two groups lymph node dissection no significant difference（ P 〉0. 05）. Blood loss of laparotomy group was significantly higher than that of the laparoscopic group（P〈 0. 05）;Postoperative hospital stay was significantly longer than that of the laparoscopic group（P 〈0. 05）; Postoperative ambulation time later than that of the laparoscopic group（ P 〈0. 05）;Intestinal function recovery time was significantly later than that of the laparoscopic group（P 〈0. 05）. Conclusion Has the advantages of clear operation visual field,less trauma,laparoscopic radical surgery for TME. Early ambulation after operation,the hospitalization time is short,in line with the current development trend of new technology of minimally invasive surgery. The operation mode has been gradually developed,is expected to become a standard treatment for rectal cancer operation node,is worthy of clinical use.