腹腔镜与开腹直肠癌手术的疗效观察

Comparative analysis of short-term outcomes of laparoscopic and open surgery for rectal cancer

目的：通过对比腹腔镜直肠癌全直肠系膜切除术（total mesorectal excision,TME）与开腹直肠癌TME术中情况、术后恢复情况、近期随访情况,探讨腹腔镜直肠癌TME的安全性与可行性。方法：回顾分析2011年3月至2012年5月20例开腹TME（对照组）及2011年5月至2012年7月20例腹腔镜TME（观察组）患者的临床资料。结果：观察组术中出血量平均（70.0±25.5）ml,术后肛门排气时间平均（2.5±0.5）d,下床活动时间平均（3.3±1.5）d,平均住院（7.7±2.4）d,均明显优于对照组,差异有统计学意义（P〈0.05）,两组手术时间[（178.4±54.7）min vs.（150.8±33.4）min]、淋巴结清扫数量[（14.5±2.6）枚vs.（13.0±3.1）枚]、标本切除长度[（13.0±5.3）cm vs.（13.8±4.8）cm]差异均无统计学意义（P〉0.05）。术后随访12~36个月,观察组局部复发1例,肝脏转移1例,对照组肝脏转移2例,尚无局部复发病例,两组差异无统计学意义（P〉0.05）。结论：腹腔镜直肠癌TME是安全、可靠的,具有切口小、出血少、康复快等优势。

Objective： By comparing the intraoperative situation and postoperative recovery,the recent follow-up situation of laparoscopic and open total mesorectal excision（ TME） for rectal cancer,to discuss the safety and feasibility of laparoscopic TME surgery. Methods： A retrospective comparison was made between 20 cases of open TME from Mar. 2011 to May 2012（ control group） and20 cases of laparoscopic TME from May 2011 to Jul. 2012（ observation group）. Results： There was no difference in baseline parameters between the two groups. The blood loss was（ 70. 0 ± 25. 5） ml in observation group,which was significantly less than that in control group（ P〈0. 05）. The flatus time [（ 2. 5 ± 0. 5） d],ambulation time [（ 3. 3 ± 1. 5） d] and hospital stay [（ 7. 7 ± 2. 4） d] of observation group were shorter than those of control group,the differences mentioned above were statistically significant（ P〈0. 05）. No significant differences were found between two groups in operation time [（ 178. 4 ± 54. 7） min vs.（ 150. 8 ± 33. 4） min] and the number of harvested lymph nodes [（ 14. 5 ± 2. 6） vs.（ 13. 0 ± 3. 1） ]and the specimen length [（ 13. 0 ± 5. 3） cm vs.（ 13. 8 ± 4. 8） cm]. During the follow-up of 12-36 months,1 case of local recurrence and 1 case of hepatic metastasis occurred in observation group,2 cases of hepatic metastasis occurred and no local recurrence was found in control group,the differences between the two groups were not statistically significant（ P〉0. 05）. Conclusions： Laparoscopic TME is safe and reliable and it has the advantages of mini-incision,little blood loss and fast recovery.