腹腔镜和开腹手术治疗低位直肠癌的临床疗效

Clinical efficacy of laparoscopy and laparotomy in the treatment of low rectal neoplasms

目的分析开腹手术和腹腔镜治疗低位直肠癌的临床疗效。方法选择2010年2月至2014年2月间收治的88例低位直肠癌患者,根据手术方法分为腹腔镜组和开腹组,每组44例。观察两组患者手术时间、术中出血量、排气时间、住院时间、术后并发症及局部复发率、远处转移率、排尿及排便障碍的发生率。结果两组患者均成功完成手术,腹腔镜组术中无转开腹手术患者。腹腔镜组患者术中出血量、排气时间及住院时间均低于开腹组(P<0.05)。两组手术时间及术后吻合口漏、吻合口出血、肠梗阻的发生率差异无统计学意义(P>0.05);腹腔镜组切口感染率为0.0%,显著低于开腹组的13.6%(P<0.05)。两组患者1年后局部复发率、远处转移率、排尿及排便障碍的发生率差异无统计学意义(P>0.05)。结论腹腔镜和开腹手术治疗低位直肠癌的手术时间、近期疗效与远期疗效相当,但腹腔镜具有出血少、恢复快、创伤小等优势,可以有效降低切口感染率,缩短住院时间,保障治疗质量。

Objective To compared the clinical efficacy of laparoscopy and laparotomy in the treatment of low rectal neoplasms. Methods From February 2010 to February 2014,88 low rectal cancer patients were enrolled as the research object. According to its operation method,they were divided into laparoscopic group and laparotomy group,44 cases in each group. The operating time,intraoperative blood loss,exhaust time,length of stay,postoperative complications,local recurrence rate,distant metastasis rate,incidence rate of urination and defecation dysfunction were compared between the two groups. Results All patients were successfully completed surgery. No patient in the laparoscopic group converted to open surgery. The intraoperative blood loss,exhaust time and hospital stay of the laparoscopic group were lower than those of the laparotomy group（ P 0. 05）; The operation time between the two groups showed no significant difference（ P 0. 05）. The postoperative anastomotic leakage,anastomotic bleeding,and incidence of intestinal obstruction between the two groups showed no significant difference（ P 0. 05）; The wound infection rate of the laparoscopic group was 0. 0%,significantly lower than that of laparotomy group（ 13. 6%）（ P 0. 05）. 1-yr local recurrence rate,distant metastasis rate and the incidence of urination and defecation disorders between the two groups showed no significant differences（ P 0. 05）. Conclusions In the treatment of low rectal cancer,Laparoscopy and laparotomy operation showed no significant differences. But laparoscopic inhibits many advantages： less bleeding,rapid recovery and small trauma and can effectively reduce the infection rate and hospitalization time.