腹腔镜手术与开腹手术对直肠癌的疗效和安全性比较

Comparative study on the therapeutic effects and safety between laparoscopic surgery and laparotomy in treatment of rectal cancer

目的：探讨腹腔镜手术根治直肠癌的措施，并与同期的开腹手术展开对照，讨论腹腔镜手术的疗效和安全性。方法选择48例行腹腔镜直肠癌患者为观察组，选择同期行开腹手术的48例直肠癌患者为对照组，对照组患者采用传统开腹手术进行治疗，观察组患者采用腹腔镜手术进行治疗，对腹腔镜手术的疗效和安全性进行评价。结果观察组手术时间显著多于对照组，术中出血量和切口长度显著少于对照组（ P ＜0．05）。2组患者术中均未输血。观察组肿瘤大小、清理淋巴结数目以及肿瘤远端切除长度与对照组比较，差异无统计学意义（ P ＞0．05）。观察组术后镇痛、术后排气时间、第1次下床时间、术后留置胃管时间、术后进流食时间、术后留置导尿时间、术后第1次排便时间和住院天数显著少于对照组，总费用显著高于对照组（ P ＜0．05）。观察组术后第1、2、3天的C－反应蛋白、白细胞计数、白介素－6显著低于对照组（ P ＜0．05），T淋巴细胞亚群CD3＋、CD4＋、CD8＋和NK细胞显著高于对照组（ P ＜0．05），2组CD4＋／CD8＋比较差异无统计学意义（ P ＞0．05）。观察组患者第1、2、3天的前白蛋白、视黄醇结合蛋白显著高于对照组，观察组第3天的转铁蛋白、白蛋白显著高于对照组（ P ＜0．05），其他时间差异无统计学意义（ P ＞0．05）。观察组患者的并发症发生率显著少于对照组（ P ＜0．05）。患者均随访12～24个月。2组患者切口转移、局部复发及远处转移情况比较差异无统计学意义（ P ＞0．05）。结论腹腔镜直肠癌手术安全、创伤小、恢复快、应激水平低、有利于机体能量代谢及内脏蛋白的恢复，较开腹直肠癌手术优越，提高了患者的生活品质。

Objective To observe and compare the therapeutic effects and safety between laparoscopic surgery and laparotomy in treatment of rectal cancer .Methods Forty-eight patients with rectal cancer who underwent laparoscopic surgery in our hospital were served as observation group ,however,the other 48 patients with rectal cancer who underwent laparotomy were served as control group .The patients in control group were treated by traditional laparotomy , however , the patients in observation group were treated by laparoscopic surgery .After operation the therapeutic effects and safety were observed and compared between two groups .Results The operation time in observation group was significantly longer than that in control group,however ,the hemorrhage volume and incision length in observation group were significantly less than those in control group （ P 〈0.05）.The patients in both groups did not undergo blood transfusion during operation .There were no significant differences in tumor size, number of cleaning lymph nodes and tumor distal excision length between two groups （ P 〈0.05）. The postoperative analgesia , postoperative exhaust air time , the first time to get out of bed , postoperative detaining gastric tube time, postoperative time to take liquid diet , postoperative urethral catheterication time , the first time of defaecation after operation and hospital day in observation group were significantly less than those in control group （ P 〈0.05）.The serum levels of CRP,WBC,IL-6 on 1d, 2d,3d after operation in observation group were significantly lower than those in control group （ P 〈0.05）,however, the levels of T lymphocyte subsets-CD3＋,CD4＋,CD8＋cells and NK cells were significantly higher than those in control group （ P 〈0.05）.The levels of PRE,RbP on 1d, 2d,3d after operation in observation group were significantly higher than those in control group （ P 〈0.05）, moreover, the levels of TRF,ALB on 3d after operation in observation group were significantly higher than those in control group （ P 〈0.05）, but there were no significant differences in the other two times after operation between two groups （ P 〈0.05）.The incidence rate of complications in observation group was significantly lower than that in control group （ P 〈0.05）.All the patients were followed up for 12~24 months. Besides there were no significant differences in incision metastasis ,local recurrence and distant metastasis between two groups （ P 〉0.05）.Conclusion The laparoscopic surgery in treatment of rectal cancer has the advantages of safety ,less trauma, quicker recovery , lower stress levels , which is helpful to the recovery of energy metabolism of organism and visceral protein , furthermore, which can improve life quality of patients ,thus,laparoscopic surgery is suprior to laparotomy in treatment of rectal cancer.