梗阻性结直肠癌导管减压后3D腹腔镜与开腹手术的疗效比较

Efficacy analysis of 3D laparoscopic and open surgery for obstructive colorectal carcinoma after tube decompression

目的:比较梗阻性结直肠癌导管减压后行3D腹腔镜与开腹根治术的疗效。方法:回顾性分析2011年5月—2013年6月96例行手术治疗的梗阻性结直肠癌患者资料,所有患者术前均行肠梗阻导管置入减压,然后50例行3D腹腔镜下行结直肠癌根治术3D(腹腔镜手术组),46例行传统开腹结直肠癌根治手术(开腹手术组),比较两组患者的相关临床指标。结果:两组患者术前资料具有可比性;腹腔镜手术组平均手术时间长于开腹手术组(5.9 h vs.5.2 h,P<0.05),平均总住院费用高于开腹手术组(3.3万元vs.2.7万元,P<0.05),但平均术后排气时间(2.4 d vs.3.0 d,P<0.05)、留置尿管时间(2.7 d vs.3.9 d,P<0.05)、住院时间(15.2 d vs.23.8 d,P<0.05)均明显短于开腹手术组;两组患者术后吻合口瘘、切口感染、腹腔脓肿和肠梗阻发生率差异均无统计学差异(均P>0.05);两组患者3年无瘤生存率无统计学差异(80.0%vs.82.6%,P=0.744)。结论:3D腹腔镜手术治疗导管减压后梗阻性结直肠癌术后恢复快,且围手术期并发症与预后方面与开腹手术相似,可作为梗阻性结直肠癌治疗的手术方式。

Objective： To compare the efficacy of 3D laparoscopic and open radical resection in treatment of obstructive colorectal cancer after transanal endoscopic tube decompression. Methods： The clinical data of 96 patients with obstructive colorectal cancer undergoing surgical treatment from May 2011 to June 2013 were retrospectively analyzed. Of the patients, all cases received transanal endoscopic tube decompression before surgery5 and then 50 cases underwent 3D laparoscopic radical resection for colorectal cancer （laparoscopic group） and 46 cases underwent open radical resection for colorectal cancer （open surgery group）. The main clinical variables between the two groups of patients were compared. Results＂ The preoperative data had comparability between the two groups. In laparosc0pic group versus open surgery group, the average operative time （5.9 h vs. 5.2 h, P〈0.05） was prolonged and overall hospitalization cost （33 000 yuan vs. 27 000 yuan, P〈0.05） was increased significantl）5 but the average time to postoperative gas passage （2.4 d vs. 3.0 d, P〈0.05）, time to postoperative urethral catheter removal （2.7 d vs. 3.9 d, P〈0.05） and length of hospital stay （15.2 d vs. 23.8 d, P〈0.0$） were all shortened significantl~ The incidences of anastomotic leakage, incision infection, intra-abdominal abscess and ileus showed no significant difference between the two groups （all P〉0.05）. The 3-year disease-free survival rates were not significantly different between the two groups （80.0% vs. 82.6%, P=0.744）. Conclusion： For obstructive colorectal cancer after tube decompression, 3D laparoscopic surgery offers fast postoperative recovery and is similar to open surgery in terms of perioperative complications and outcomes. It can be considered as an alternative procedure for obstructive colorectal cancer.