腹腔镜全直肠系膜切除术治疗中低位直肠癌的疗效与安全性观察

Curative Effect and Safety Observation on Laparoscopic Total Mesorectal Excision for Treatment of Middle and Low Rectal Cancer

目的探讨腹腔镜全直肠系膜切除术治疗中低位直肠癌的近期疗效,评价其治疗中低位直肠癌的安全性和可行性。方法选择中低位直肠癌患者65例,分为观察组33例和对照组各32例,观察组采用腹腔镜全直肠系膜切除术,对照组采用开腹手术,比较术中、术后情况及并发症。结果观察组患者手术时间长于对照组,术中出血量及保肛率优于对照组,差异有统计学意义(P<0.05);二者淋巴结清扫数目及肿瘤下缘与远切缘距离相似,差异无统计学意义(P>0.05)。观察组胃肠道功能恢复、切口愈合及术后住院时间均短于对照组,差异有统计学意义(P<0.05)。观察组术后并发症发生率6.06%,低于对照组的28.13%,差异有统计学意义(P<0.05)。结论腹腔镜全直肠系膜切除术治疗中低位直肠癌的近期疗效与开腹手术相似,但具有明显的微创优势,安全可行。

Objective In order to investigate short-term curative effects of laparoscopic total mesorectal excision for treat-ment of middle and low rectal cancer,and in order to evaluate safety and validity of the therapy for treatment of middle and low rec-tal cancer. Methods 65 cases of patients with middle and low rectal cancer were selected in this study,33 cases of patients were distributed into the observation group,and 32 cases of patients were distributed into the control group,patients in the observation group were treated with laparoscopic total mesorectal excision,and patients in the control group were treated with laparotomy,intra-operative conditions,postoperative conditions and occurrence rate of complications were compared. Results Operation time of the patients in the observation group was longer than that in the control group,intraoperatve blood soss and rate of anal preservation of the patients in the observation group were superior than that in the control group,the differences had statistical significance（ P〈0. 05）,lymph node dissection number and the distance between tumorous inferior margin and distal incisal margin were similar in the two groups,the differences had no statistical significance（P＆gt;0. 05）. Gastroenteric function recovery time,wound healing time and postoperative hospital stays of the patients in the observation group were shorter than that in the control group,the differences had statistical significance（P〈0. 05）. Occurrence rate of postoperative complications in the observation group was 6. 06%,which was lower than that in the control group （ 28. 13%） , the differences had statistical significance （ P〈0. 05 ） . Conclusion Short-term curative effects of laparoscopic total mesorectal excision and laparotomy for treatment of middle and low rectal cancer were similar,but laparoscopic total mesorectal excision has obvious minimally invasive advantage,and the therapy is more safe and feasi-ble.