腹腔镜辅助与开腹结直肠癌根治术临床对比研究

Laparoscopic assisted colorectal cancer surgery and open colectomy for colon cancer

目的对比研究腹腔镜辅助与开腹结直肠癌根治术的安全性及根治疗效。方法选取2010年2月至2012年2月结直肠的患者252例，前瞻性非随机（根据患者意愿）将入选病例分为腹腔镜组（143例）及开腹组109例。将所得数据采用SPSS19．0软件检验分析。术前、术后指标、肿瘤大小、结肠标本的大小、直肠标本的大小、直肠下切端距离及淋巴结清扫枚数采用元±s表示并用t检验，近期并发症、复发率、转移率及远期并发症采用率表示并用Ⅳ。检验，检验标准a=0．05，P〈0．05则具有统计学意义。结果腹腔镜的手术时间长于开腹组[（156．8±52．3）min比（143．5±41．9）min，t=2．187，P〈0．05]。腹腔组的术中失血、术后排气时间、术后下床时间、术后进食流食时间及术后住院时间的指标优于开腹组[（83．8±26．7）ml比（173．2±39．5）ml，（2．2±0．7）d比（3．9±0．9）d，（2．4±0．6）d比（3．2±1．1）d，（3．0±0．8）d比（4．3±0．9）d，（6．8±1．3）d比（8．9±1．6）d，t：21．368，t=16．867，t=7．349，t=12．123，t=11．496，P〈0．05]。两组术后近期并发症、切除的肿瘤大小、结肠标本的大小、直肠标本的大小、直肠下切端距离及淋巴结清扫枚数、局部复发率、远处转移率、术后远期并发症发生率及3年生存率差异无统计学意义（P〉0．05）。结论本研究腹腔镜结直肠癌手术具有开腹手术相同的手术安全性及肿瘤根治效果，近期疗效优于开腹手术，远期疗效与开腹手术无显著差异。

Objective The aim of the current study is to compare the short-term and long-term outcomes of laparoscopic-assisted surgery and conventional open surgery. Methods A total of 252 patients with non-metastatic colorectal cancer were enrolled in this study. The patients underwent either aparoscopic-assisted surgery（n=143） or open surgery（n=109）. Clinical data were analyzed using SPSS19. 0 software. Operation time, intraoperative blood loss, postoperative exhaust time, postoperative ambulation time,postoperative liquid diet time,postoperative hospitalization time,tumor size,the size of specimen,colon rectal specimens,the distance between the rectum incision margin and the anus as well as the number of dissected lymph nodes were expressed as and tested by Student＇s t test. The incidences of complications,recurrent metastasis, and long-term complications were tested by the Chi-square test（alpha = 0.05） P〈 0. 05 was considered statistically significant. Results The average operation time in the laparoscopic surgery group was longer than that in the laparotomy group [（156.8±52.3） min vs（143.5±41.9） min,t = 2. 187,P〈 0. 05]. There was no statistically significant difference in the incidence of postoperative complications. There were significant differences between the laparoscopic assisted surgery group and open surgery group in the volume of blood loss during operation,postoperative exhaust time,post liquid diet time and postoperative hospitalization time [（83. 8 ± 26. 7） ml vs.（173. 2 ±39. 5） ml,（2. 2 ± 0. 7） d vs.（3. 9 ± 0. 9） d,（2. 4 ± 0. 6） d vs.（3. 2 ± 1. 1） d,（3. 0 ± 0. 8） d vs.（4. 3 ±0. 9） d,（6. 8 ± 1. 3） d vs.（8. 9 ± 1. 6） d,t = 21. 368,t = 16. 867,t = 7. 349,t = 12. 123,t = 11. 496,P〈 0. 05]. No significant differences were identified in tumor size,operative site and extent between these two groups. The number of lymph node dissection was also similar in the two groups（P〈 0. 05）. No significant differences were found in the local recurrence rate,distant metastasis rat,the incidence of long-term complications and the overall survival rate three years after operation（P〈 0. 05）. Conclusion Laparoscopic-assisted procedure has better short-term outcomes including postoperative recovery than open surgery,but it has equal long-term outcomes as does open surgery in the treatment of non-metastasis colorectal cancer.