腹腔镜与开腹低位直肠癌保肛手术临床疗效比较

Comparison of the Clinical Effects of Laparoscopic and Open Anus Preserving Surgery for Low Rectal Cancer

目的探讨腹腔镜技术在低位直肠癌保肛手术中的应用价值。方法回顾性分析85例低位直肠癌患者的临床资料,其中腹腔镜手术组45例(实验组),开腹手术组40例(对照组);分析对比实验组和对照组患者的手术实施时间、手术出血量、手术体表的切口长度、手术后肛门恢复排气时间、术后腹腔引流量、术后并发症(吻合口瘘、切口感染)等指标。结果实验组手术时间(169±40)min,长于对照组(120±50)min(P<0.05),实验组术中出血量(56±23)ml,较对照组(248±92)ml显著减少(P<0.05),实验组切口长度(4.0±1.3)cm,短于对照组的(15.0±3.2)cm(P<0.05),术后肛门恢复排气时间实验组(37±11)h,较对照组(73±12)h快(P<0.05),术后引流量实验组(31±15)ml,较对照组(385±65)ml显著减少(P<0.05),实验组术后吻合口出血并吻合口瘘1例(2.2%),较对照组4例(10%)少(P<0.05),实验组无切口感染,较对照组4例(10%)少(P<0.05),并发症发生率实验组为2.2%,显著低于对照组的20%(P<0.05)。结论低位直肠癌的腹腔镜前切除术具有更小的手术创伤、更少的术中出血、更快的术后恢复、更少的术后并发症等优点,治疗效果确切,值得临床应用推广。

Objective To evaluate the application value of laparoscopic anus preserving surgery for low rectal cancer patients. Methods Eighty-five patients with low rectal cancers were studied respectively.There were forty-five patients in laparoscopic operation group treated with laparoscopic anus preserving operation,and forty patients in open operation group. Operation time,intra-operative hemorrhage,length of operative incision,resuming time of bowel function,postoperative drainage time and volume,complications such as anastomotic fistula and incision infection were compared between the two groups. Results In the laparoscopic operation group and the open operation group,it showed significant differences in operation time of（169 ± 40） min vs.（120 ±50） min,the hemorrhage volume of（56 ±23） ml vs.（248 ±92） ml（P 0. 05）,the length of operative incision of（4. 0 ± 1. 3） cm vs.（15. 0 ± 3. 2） cm（P 0. 05）,the resuming time of bowel functionof（37 ± 11） h vs.（73 ± 12） h（P 0. 05）,the postoperative drainage volume of（31 ± 15） ml vs.（385 ± 65） ml（P 0. 05）,the rate of anastomotic leakage of 2. 2% vs. 10%（P 0. 05）,and the rate of incision infection of 0 vs. 10%（P 0. 05）. Conclusion It demonstrates advantages of less surgical trauma,less intra-operative bleeding,quicker postoperative recovery and few postoperative complications of laparoscopic anus preserving surgery for low rectal cancer. It is feasible,safe and worthy of clinical popularization and application.