单吻合器法腹腔镜全直肠系膜切除术与开腹手术的对照研究

Comparison study of laparoscopic total mesorectal excision using single stapler and total mesorectal excision with open technique

目的比较单吻合器法腹腔镜全直肠系膜切除术(TME)与开腹TME的临床效果。方法回顾性对比分析2014年1月至2015年1月解放军海军安庆医院普通外科收治的39例行TME患者的临床资料,其中单吻合器法腹腔镜TME患者15例(腹腔镜组),行开腹TME患者24例(开腹组)。结果两组患者均顺利完成手术,腹腔镜组的术后肛门排气时间、术中出血量、疼痛评分[(2.7±0.8)d、(45.7±24.6)ml、(2.3±0.9)分]明显低于开腹组[(4.4±1.2)d、(121.7±137.3)ml、(6.4±1.5)分],差异有统计学意义(P<0.05)。腹腔镜组的住院费用、清扫淋巴结数量、术后住院时间[(26 187.1±7 484.6)元、(9.9±5.6)枚、(14.6±4.6)d]与开腹组[(22 466.2±4 972.8)元、(9.0±4.8)枚、(16.2±4.8)d]比较,差异无统计学意义(P>0.05);腹腔镜组的手术时间(252.3±54.2)min比开腹组(147.3±41.3)min长,差异有统计学意义(P<0.05)。结论单吻合器法腹腔镜TME具有安全、微创、经济等优势,能够取得与开腹手术同样的肿瘤根治性效果,在经济欠发达地区很有实用价值。

Objective To compare the clinical effect of laparoscopic total mesorectal excision using single stapler and total mesorectal excision with open technique. Methods The clinical data of 39 patients of total mesorectal excision in this hospital from Jan. 2014 to Jan. 2015 were analyzed retrospectively, in which 15 patients received laparoscopic total mesorectal excision （laparoscopic group） ,24 patients received total mesorectal excision with open technique （ open group）. Results All the operations were successfully completed. Compared with the open group, recovery anal exhaust time、 intraoprative bleeding、 pain scores [（2. 7 ±0. 8）d 、 （45. 7 ± 24.6） ml、 （ 2. 3 ± 0.9 ） scores] were significantly decreased in the laparoscopic group（ P 〈 0. 05 ） . The hospitalization expenses, number of lymph node dissection and postoperative hospital stay had no significant differences between the laparoscopic group [ （26 187. 1 ± 7 484. 6 ） yuan、（ 9. 9 土 5. 6） lymph、（ 14. 6 ± 4. 6 ） d ] and the open group [（ 22 466. 2 ± 4 972. 8 ） yuan、（ 9. 0 ± 4. 8 ） lymph、 （16.2±4.8）d]（P〉 0. 05）. The operative time of the laparoscopic group [（ 252. 3 ± 54. 2 ） min] is longer than the open group [（ 147. 3 ±41.3 ） min] （ P 〈0.05 ）. Conclusions Laparoscopic total mesorectal excision using single stapler has the advantages of safe, minimally invasive, economical etc. It has the same tumor radical effect and has a high promotional value economically underdeveloped regions.