手辅助腹腔镜与开腹乙状结肠癌根治术疗效对比的前瞻性对照研究

Comparison of postoperative outcomes between hand-assisted laparoscopic and conventional sigmoidectomy：a prospective non-randomized controlled trial

目的：对比手辅助腹腔镜技术（HALS）与开腹手术在乙状结肠癌治疗中的安全性及疗效。方法前瞻性入组2010年1月至2013年6月间北京大学肿瘤医院结直肠外科收治的291例乙状结肠癌患者，非随机分为HALS组（200例）和开腹组（91例），对比两组患者的手术安全性及疗效。结果两组患者手术时间、术中淋巴结清扫数目和术后并发症发生率差异均无统计学意义（均P＞0．05）。但HALS组患者较开腹组术中出血量明显减少[（57．9±28．3） ml比（82．5±47．6） ml， P＝0．000]，术后排气时间明显加快[（3．0±1．4） d比（3．3±0．9） d， P＝0．000]，术后住院时间明显缩短[（7．3±4．2） d比（8．9±4．4） d， P＝0．004]。术后随访6月至3年，两组患者总生存时间和无病生存时间的差异均无统计学意义（P＝0．391和P＝0．167）。结论 HALS技术用于乙状结肠癌根治术可达到与开腹手术相同的治疗效果，且微创优势明显。

Objective To compare the perioperative safety and efficacy between hand-assisted laparoscopic surgery （HALS） and conventional open sigmoidectomy. Methods A total of 291 patients with sigmoid colon cancer who underwent surgery in our hospital from January 2010 to June 2013 were seperated into （HALS） group （n=200） and conventional open surgery （COS） group （n=91） with a non-randomized method. The perioperative safety and efficacy of two groups and perioperative outcomes were compared. Results These two groups were comparable in operative time, lymph node harvest, and postoperative complications. However, HALS group had less intraoperative bleeding [（57.9±28.3） ml vs. （82.5±47.6） ml, P=0.000], shorter time to flatus[（3.0±1.4） d vs. （3.3±0.9） d, P=0.000], and shorter hospital stay[（7.3±4.2） d vs. （8.9±4.4） d, P=0.004]. There werer no significant differences in overall survival time and disease-free survival time between the two groups during 6 months to 3 years follow-up. Conclusions HALS results in similar outcomes of conventional open surgery for sigmoidectomy with the advantage of minimal invasiveness.