腹腔镜下直肠癌根治术与开腹直肠癌根治术近期临床疗效比较

Comparison of Short-term Clinical Curative Effect of Laparoscopy and Laparotomy for Rectal Cancer

目的对比腹腔镜直肠癌根治术与开腹直肠癌根治术的近期临床疗效。方法将2009年2月至2013年2月深圳市第二人民医院收治的102例直肠癌患者按随机数字表法分为两组,腹腔镜组62例采用腹腔镜直肠癌根治术治疗,开腹组40例采用开腹直肠癌根治术治疗,比较两组患者围手术期情况、肿瘤根治情况及并发症发生率。结果腹腔镜组手术时间长于开腹组[(162±22)min比(139±17)min,P<0.05],术中出血量少于开腹组[(106±29)m L比(158±36)m L,P<0.01],切口长度小于开腹组[(5.4±1.7)cm比(10.1±2.6)cm,P<0.01],下床活动时间、排气时间及术后住院时间均短于开腹组[(4.9±1.3)d比(5.8±1.2)d,(2.9±0.9)d比(3.5±1.0)d,(10.2±2.8)d比(13.1±3.2)d,P<0.01];两组患者肿瘤大小、结肠和直肠切除长度、肿瘤距下切缘距离及淋巴结清扫数量差异均无统计学意义(P>0.05);腹腔镜组出现吻合口瘘、吻合口出血、肠梗阻、肺部感染各1例,开腹组出现吻合口瘘、吻合口出血、尿潴留各1例,肠梗阻4例,切口感染3例,肺部感染5例,腹腔镜组总并发症发生率低于开腹组(6.4%比37.5%,P<0.05)。结论腹腔镜直肠癌根治术创伤小,出血少,并发症少,并未缩小肿瘤根治范围,总体近期疗效优于开腹手术,可作为直肠癌有效的治疗手段之一。

Objective To compare the short-term efficacy of laparoscopy and laparotomy for rectal cancer. Methods A total of 102 patients with rectal cancer admitted to Shenzhen Second People＇s Hospital from Feb. 2009 to Feb. 2013 were divided into two groups according to random number table method： the laparoscopy group（ 62 cases） were treated with laparoscopic radical resection,40 patients in the laparotomy group were treated with laparotomy resection,and then the conditions of the patients in perioperative period,radical resection condition of tumor and the complication rates of the two groups were compared. Results The operation time of the laparoscopic group was longer than the laparotomy group[（ 162 ± 22） min vs（ 139 ± 17） min,P〈0. 05],the blood loss was less than the laparotomy group [（ 106 ± 29） m L vs（ 158 ± 36） m L,P〈0. 05],and the incision length was shorter than the laparotomy group[（ 5. 4 ± 1. 7） cm vs（ 10. 1 ± 2. 6） cm,P〈0. 05],the postoperative activity time,the exhaust time and the postoperative hospitalization time were shorter than the laparotomy group[（ 4. 9 ± 1. 3） d vs（ 5. 8 ± 1. 2） d,（ 2. 9 ± 0. 9） d vs（ 3. 5 ± 1. 0） d,（ 10. 2 ± 2. 8） d vs（ 13. 1 ± 3. 2） d,P〈0. 01]; the size of tumors,the resection length of colon and rectum,the distance from tumor to incision edge and the amount of lymph node dissection had no statistically significant differences between the two groups（ P〉0. 05）; there was 1 case of anastomotic leakage,1 case of anastomotic bleeding,1 case of intestinal obstruction,1 case of pulmonary infection in laparoscopy group,there was 1 case of anastomotic leakage,1 case of anastomotic bleeding,1 case of urinary retention,4 cases of intestinal obstruction,4 cases of incision infection,5 cases of pulmonary infection in the laparotomy group,and the total complication rate of the laparoscopic group was lower than that in the laparotomy group（ 6. 4%vs 37. 5%,P 0. 05）. Conclusion The laparoscopic rectal cancer surgery has the advantages of little trauma,less blood loss,fewer complications,without reducing the tumor radical resection range,and the total curative effect is better than laparotomy,which can be used as one of the effective treatments for rectal cancer.