腹腔镜和开腹直肠全系膜切除术在中下段直肠癌保肛治疗中的效果比较

Comparative analysis of laparoscopic and open total mesorectal excision for the sphincter-saving operation on middle and lower section of col-orectal cancer

目的探讨腹腔镜直肠全系膜切除术在中下段直肠癌保肛治疗中的安全性。方法回顾性对比分析莆田市第一医院2010年6月-2016年1月同期开展的开腹中下段直肠癌全系膜切除的保肛病例与腹腔镜中下直肠癌全系膜切除的保肛病例的临床效果。全部病例按随机数字表法分为开腹组（361例）和腹腔镜组（289例）,比较两组手术时间、术中出血量、切口长度、胃肠道功能恢复时间、术后自主排尿时间、术后住院时间、平均淋巴结清除数目、远端切缘距肿瘤长度、局部复发率、预防性回肠造瘘和术后总并发症发生率情况。结果开腹组与腹腔镜组的手术时间[（143.8±14.9）min比（192.0±20.5）min]、出血量[（262.5±48.9）m L比（92.0±46.1）m L]、切口长度[（21.9±1.7）cm比（5.7±0.8）cm]、胃肠道恢复时间[（2.9±0.5）d比（1.5±0.5）d]、术后自主排尿时间[（10.0±1.2）d比（6.3±0.9）d],和术后住院时间[（15.4±1.3）d比（9.7±1.3）d]比较,差异均有统计学意义（均P〈0.01）。两组的平均淋巴结清除数目、远端切缘距肿瘤长度、局部复发率、预防性回肠造瘘和术后总并发症发生率比较差异均无统计学意义（均P〉0.05）。结论腹腔镜直肠全系膜切除在中下段直肠癌保肛治疗中安全、可行。

Objective To probe the security of laparoscopic Total Mesorectal Excision（TME） for the sphincter-saving operation on middle and lower section of colorectal cancer. Methods The clinical effect on the cases who underwent TME for the sphincter-saving open surgery and laparoscopic surgery on middle and lower section of colorectal cancer in Putian First Hospital from June 2010 to January 2016 was retrospectively analyzed. The cases were randomly divided into open surgery group（n=361） and laparoscopic surgery group（n=289）, and the time of operation, the blood loss, the length of incision, the recovery time of gastrointestinal tract, the self-urination time, hospital stays, the number of lymph nodes, the length of distal cut edge from the tumor, the local recurrence rate, the prophylactic ileum stoma rate and the postopration total complications rate of two groups were compared. Results There were significant differences in these indexes（P〈0.01）; The time of operation on open surgery group and laparoscopic surgery group were（143.8±14.9）min and（192.0±20.5）min, the blood loss were（262.5±48.9）m L and（92.0±46.1） m L, the length of incision were（21.9±1.7）cm and（5.7±0.8）cm, the recovery time of gastrointestinal tract were（2.9±0.5）days and（1.5±0.5）days, the self-urination time（10.0 ±1.2）days and（6.3 ±0.9）days, postoperation hospital stay were（15.4 ±1.3）days and（9.7 ±1.3）days. And there were no significant differences in the other indexes such as the number of lymph nodes（P〉0.05）.Conclusion It is safe and feasible in the laparoscopic TME for the sphincter-saving operation on middle and lower section of colorectal cancer.