对比常规开腹手术和腹腔镜下直肠癌手术的近期疗效及安全性分析

Short term efficacy and safety of laparoscopic and open rectal cancer surgery

目的观察探讨应用常规开腹手术和腹腔镜下直肠癌手术的近期疗效以及安全性分析。方法选取蚌埠市第三人民医院2009年5月—2016年12月收纳的60例直肠癌手术患者,按手术方式分为常规开腹手术组和腹腔镜组,常规开腹手术组30例采用常规开腹直肠癌根治术,腹腔镜组30例采用腹腔镜直肠癌根治术,记录2组患者各自术中情况、术后排气、导尿管留置时间等近期疗效指标,记录术后出现的并发症并追踪患者5年生存率。结果腹腔镜组患者住院时间短于常规开腹手术组,早期进行下床活动时间及排气时间,留置导尿管时间及进食流质时间均早于开腹手术组,切口长度短,术后疼痛感评分低于开腹手术组,但住院费用较高,手术时间较长,常规开腹手术组和腹腔镜组直肠癌手术患者近期疗效对比差异均有统计学意义(P<0.05)。常规开腹手术组并发症发生率为60.00%,腹腔镜组并发症发生率为26.67%,腹腔镜组并发症更低,安全性高(P<0.05)。腹腔镜组患者在1年、3年到5年的随访中,总生存率均略高于常规开腹手术组,但2组差异无统计学意义(P>0.05),5年腹腔镜组>60岁患者的存活比例为46.67%,高于常规开腹组20.00%(P<0.05)。结论腹腔镜治疗直肠癌手术根治疗效显著,手术近期疗效优于常规开腹手术,肿瘤根治率较高,手术时间短,术后恢复快,患者可尽早进行下床活动。腹腔镜治疗直肠癌手术术后并发症少,安全性较高,高龄患者远期生存率也能得到一定程度的提升。

Objective To compare the efficacy and safety of laparoscopic and open rectal cancer surgery in the treatment of rectal cancer. Methods Total 60 cases of rectal cancer in our hospital between May ,2009 and December,2016 were enrolled and divided into conventional open surgery group（ group A） and laparoseopic group（ group B） according to the operation mode with 30 cases in each group. The conventional open resection was performed in the group A, while laparo- scopic resection was performed in the group B. The intraoperative conditions, time to first flatus, duration of indwelling uri- nary catheter, and the incidence of postoperative complications were documented ;The patients was followed to observe the five-year survival rate. Results The duration of hospital stays in group B was shorter than that in group A,while the time to ambulation, time to first flatus, duration of indwelling urinary catheter, and postoperative time to feeding liquid diets in group A were all shorter than in group B. The surgical incision in group B was smaller than that in the group A, and the pain score in group B was lower than that in group A. However,the hospital expenses and operation duration in group B excessed those in group A. There was significant difference in the short term efficacy between the two groups（ P 〈 0.05 ）. The incidence of complication was 60.00% in the group A and 26.67% in the group B, the difference was significant （ P 〈 0.05 ）. The 1- ,3- and 5-year follow-up showed that the overall survival rate in the group B was slightly higher than that in group A, but there was no statistical significance （ P 〉 0.05 ）. In the patients ager over 60 years, the survival rate beyond 5 years was 46.67% in group B, which was higher than 20.00% in the group A （ P 〈 0.05 ）. Conclusion The therapeutic effects of laparoscopic rectal cancer surgery for rectal cancer was remarkable, with a better short-term out- come, higher radical rate, less operation time, quick postoperative recovery, early postoperative ambulation, lower incidence of complications and higher safety. It can also improve to some extent the long-term survival rate in senile patients.