腹腔镜与传统开放手术联合新辅助放化疗治疗中低位局部进展期直肠癌的安全性及并发症的比较

Comparison of safety and rate of postoperative complications between laparoscopic and open radical resection for mid or low rectal cancer following neoadjuvant chemoradiotherapy

目的 探讨腹腔镜和开腹直肠癌根治术联合新辅助放化疗在中低位直肠癌中的安全性及并发症的差异.方法 将我科收治的112例中低位直肠癌患者随机分为实验组和对照组各56例,所有患者均予以新辅助放化疗治疗措施,实验组给予腹腔镜手术进行治疗,对照组行传统的开腹手术.观察并比较两组患者肿瘤治疗情况（清扫淋巴结总数、肿瘤切除标本的远、近切端长度、环周及远端切缘阳性率、保肛率以及术后短期并发症发生率等）.结果 腹腔镜组患者远切端长度、保肛率均明显高于开腹组,差异有统计学意义（P＜0.05）;腹腔镜组与开腹组患者术后总的并发症发生率分别为5.35％（3/56）与33.92％（19/56）,差异有统计学意义（P＜0.01）.结论 进展期直肠癌术前行同步放化疗后,腹腔镜手术优于开腹手术,安全有效.

Objective To investigate the safety and rate of postoperative complications between laparoscopic and open radical resection for mid or low rectal cancer following neoadjuvant chemoradiotherapy.Methods 112 patients with middle and low rectal cancer admitted to our department were randomly divided into observation group and control group,with 56 cases in each group.All patients were treated with neoadjuvant chemoradiotherapy.The patients in the observation group were given laparoscopic surgery （LS）,and those in the control group received traditional open surgery （OS）.The tumor treatment conditions （the distal and proximal cut-off lengths of tumor resection specimens,the positive rate of circumferential and distal resection margins,the rate of anal preservation and the short-term complications after surgery） of the two groups were observed and compared.Results The rate of anal preservation and the distal cut-off length in the LS group were significantly increased as compared with those in the OS group （P〈0.05）.The overall incidence of postoperative complications in LS group and OS group was 5.35% （3/56） and 33.92% （19/56） respectively,with the difference being statistically significant （P 〈 0.01）.Conclusion Compared to the patients with advanced rectal cancer which had received neoadjuvant chemoradiation therapy,LS is better than OS in the safety and effect.