中低位进展期直肠癌长程新辅助放化疗后腹腔镜手术疗效分析

Evaluation of the efficacy of laparoscopic surgery in treatment of advanced mid-low rectal cancer ;following a long-term neoadjuvant chemoradiotherapy

目的探讨中低位直肠癌行新辅助放化疗后经腹腔镜手术的疗效。方法将2010年1月至2013年1月新疆医科大学附属肿瘤医院收治的74例行新辅助治疗的直肠癌患者，分为腹腔镜组（36例）及开腹组（38例）进行手术，比较两组患者的近期疗效及远期疗效。结果腹腔镜组与开腹组患者术中出血量（50 ml与100 ml）、术后排气时间（2.0 d与3.0 d）及近期并发症发生率（19.4％与42.1％）差异均有统计学意义（均P＜0.05）；淋巴结清扫数目（8个与10个）、手术时间（240.0 min与231.5 min）、住院时间（22.0 d与21.5 d）及术后3年无瘤生存率（53.0％与43.8％）及总生存率（70.0％与62.9％）差异均无统计学意义（均P＞0.05）。结论腹腔镜手术治疗新辅助放化疗后进展期中低位直肠癌是一种安全有效的选择，与开腹手术根治性治疗远期疗效相似，创伤小、恢复快，远期疗效满意，具较好的应用前景。

Objective To explore the efficacy of laparoscopic surgery in treatment of advanced mid -low rectal cancer following a long-term neoadjuvant chemoradiotherapy.Methods Clinicopathologic and perioperative data were collected retrospectively from 74 patients with advanced mid-low rectal cancer , who received both neoadjuvant chemoradiotherapy and resections between January 2010 and January 2013 at Xinjiang tumor hospital.Routine follow-up was conducted.The safety and long-term survival of 36 patients who underwent laparoscopic resection were compared with those of 38 patients who received conventional resection.Results The laparoscopic group had less amount of blood loss during surgery （50 ml vs 100 ml, P〈0.05 ）.The time needed for recovery of gastrointestinal function in the laparoscopic group was significantly shorter than that in the open surgery group （ 2.0 d vs 3.0 d, P〈0.05 ）.The rate of postoperative complication was 19.4% and 42.1% （ P〈0.05 ） , respectively.In terms of the range of radical surgery and the numbers of dissected lymph nodes （8 and 10, P〉0.05）, no significant difference were found in the two groups.The operation duration and hospital stay in the laparoscopic group was longer than that in the open surgery group （ 240.0 min vs 231.5 min , P〉0.05 ） （ 22.0 d vs 21.5 d , P〉0.05）, but no significant difference was found between the two groups.There were no significant difference in the incidence of 3 disease-free survival rate （ 53.0% vs 43.8%, P〉0.05 ） and overall survival rate （70.0% vs 62.9%, P〉0.05 ） between two groups.Conclusion Laparoscopic surgery is a safe and feasible option for advanced mid-low rectal cancer patients who undergone the neoadjuvant chemoradiotherapy because of the similar rate of radical resection and satisfied long-term outcomes , which will have a better prospect in the future.