腹腔镜直肠癌根治术与传统开腹术的疗效比较

Comparison of curative effect of laparoscopic radical resection of rectal cancer and traditional open surgery

目的:回顾性研究腹腔镜根治术及传统开腹Dixon术在直肠癌中的治疗疗效。方法:选取2010年2月至2011年8月我院收治的124例直肠癌患者作为研究对象,根据治疗方法不同分为腹腔镜组(68例)和传统手术组(56例)。腹腔镜组患者首先置入腹腔镜,然后在腹腔镜辅助下进行肠段的切除和吻合;传统手术组首先在下腹部做切口,然后对游离出的直肠进行肠段的切除和吻合,并在术后进行5年随访。回顾性分析两组患者的手术相关指标、术后并发症、远期疗效以及5年累积生存率等。结果:与传统手术组相比,腹腔镜组患者的手术时间[(171.33±38.41)min]明显延长,术中出血量[(162.87±31.44)ml]及术后腹腔引流量[(140.57±42.33)ml]明显降低,肛门排气时间[(2.37±0.42)d]和住院时间[(10.16±2.27)d]缩短;在随访中发现,与传统手术组患者相比,腹腔镜组患者的切口感染、吻合口瘘、吻合口出血以及肠梗阻等术后并发症的发生率显著降低,而且腹腔镜组患者的局部复发率以及性、排尿功能障碍发生率较传统手术组患者更低,差异均有统计学意义(P<0.05)。5年累积生存率(77.9%)显著提高,差异均有统计学意义(P<0.05)。结论:腹腔镜根治术相比传统开腹Dixon术,其手术创伤较小、术后恢复快,术后并发症发生率及肿瘤复发率少,生存率更高,具有更好的临床效果,值得进一步推广。

Objective: To retrospectively study the clinical efficacy of laparoscopic versus conventional Dixon surgery in rectal cancer. Methods: 124 cases diagnosed with rectal cancer were selected as the research subjects form February 2010 to August 2011. 56 cases treated with conventional Dixon surgery were selected as conventional Dixon surgery group,and 68 cases treated with laparoscopic were selected as laparoscopic group. Patients in the laparoscopic group were first inserted laparoscope,and taken intestinal resection and anastomosis in laparoscopic. Patients in the conventional surgery group were first taken incision in the abdomen,and then the resection and anastomosis of intestinal segment of rectum were taken. Follow up for 5 years after surgery was carried out. The indicators in surgery,postoperative complications,long-term effect and cumulative survival rate were retrospectively analyzed. Results: Compared with conventional Dixon surgery group,the operation time [( 171. 33 ± 38. 41) min] in laparoscopic group was significantly increased,and the blood loss [( 162. 87 ± 31. 44) ml],peritoneal drainage [( 140. 57 ± 42. 33) ml]were significantly decreased,and flatus time [( 2. 37 ± 0. 42) d],hospitalization time [( 10. 16 ± 2. 27) d] were shorted. At follow-up,compared with conventional Dixon surgery group,the rates of incision infection,anastomotic leakage,anastomotic bleeding,bowel obstruction and sexual function and micturition dysfunction,local recurrence were significantly decreased( P < 0. 05). The five-year cumulative survival rate(77. 9%) was increased in laparoscopic group,and these differences were statistically significant( P < 0. 05). Conclusion:Compared with Dixon surgery,the laparoscopy was associated with minimal invasion,quicker recovery,fewer complication and higher survival,and it's worth promoting and applying.