减孔与多孔腹腔镜手术治疗直肠癌临床疗效对比研究

Comparative study of clinical curative effect on reduced incision laparoscopic surgery and multi-incision laparoscopic surgery in rectal cancer

目的探讨减孔腹腔镜手术在直肠癌手术中的近期和远期疗效。方法回顾性分析2010年6月至2012年6月辽宁省肿瘤医院结直肠外科收治的124例腹腔镜直肠癌手术病人临床资料,排除高龄、心肺等重要器官功能障碍、肿瘤下缘距肛缘<6 cm及Ⅰ、Ⅳ期直肠癌病例。其中62例行减孔(2孔)腹腔镜手术(减孔组),62例同期行多孔腹腔镜手术(多孔组)。结果两组在手术时间、术中出血量、淋巴结清扫数目、切口感染发生率、吻合口漏发生率、保肛率、标本完整性、近切缘距离、远切缘距离、环周切缘阳性率、远端切缘阳性率、局部复发率、3年无病存活率、3年总存活率等方面差异无统计学意义(P值均>0.05);在切口总长度、术后第1、2日疼痛评分、术后第1次排气时间、术后第1次下地活动时间等方面差异有统计学意义(P值均<0.05)。结论减孔腹腔镜直肠癌手术可以减少切口总长度、减轻术后疼痛、缩短肛门排气时间、提高美容效果;手术时间未显著延长,并在肿瘤手术质量、3年无病存活率、3年总存活率方面不劣于多孔腹腔镜手术。

Objective To investigate the short-term and long-term clinical curative effects on redued incision laparoscopic surgery and multi-incision laparoscopic surgery in rectal cancer. Methods A retrospective study of 124 cases of rectal cancer admitted from June 2010 to June 2012 in Liaoning Cancer Hospital was conducted,in which were excluded the cases with high years old and dysfunction of the heart and lung or the other important viscera,and with the distance less than 6 cm from the inferior tumor margin to the anal edge and the rectal cancer of the Ⅰand Ⅳstages. A total of 62 cases proceeded the reduced incision laparoscopic surgery （reduced incision group） and 62 cases undergone the multi-incision laparoscopic surgery（multi-incision group）simultaneously. Results Two groups had no statistically significant difference in operative time, intraoperative bleeding, the number of lymph node harvest, the incidence of anastomotic leakage and anus reserved, completeness of specimen, distance to proximal margin,ditance to distal margin, positive rate of circumferencial resection margin （CRM） and distal resection margin （DRM）, local recurrence rate, 3-year disease free survival rate, 3-year overall survival rate, etc.（ all P〉0.05）.But the total length of incision,postoperative pain score of the first and the second day,anal exhausting time, independently walking for the first time between two groups had statistically significant diferences（ all P〈0.05）. Conclusion Reduced incision laparoscopic rectal cancer surgery can decrease the total length of incision, lower postoperative pain degree,shorten anal exhausting time,and improve cosmetic effect. And the kind of approach does not prolong operative time significantly,and the quality of tumor resection,and 3-year disease free survival rate, 3-year overall survival rate are not inferior to multi-incision laparoscopic surgery.