头侧中间入路腹腔镜手术治疗直肠癌的临床疗效观察

Clinical effects of laparoscopic surgery by cephalo-medial to lateral approach in the treatment of rectal cancer

目的研究头侧中间入路腹腔镜手术治疗直肠癌的临床效果。方法纳入2012年8月至2014年3月本院收治的70例直肠癌患者作为研究对象,随机分为观察组及对照组,每组各35例。观察组行头侧中间入路腹腔镜直肠癌根治术,对照组行传统中间入路腹腔镜根治术。比较两组手术时间、术中出血量、淋巴结清扫、术后肛门排气时间及住院时间等手术基本情况,记录两组术后并发症。术后进入随访,记录两组3年总生存率和无事件生存率。结果观察组手术时间显著短于对照组,第253组淋巴结清扫数显著多于对照组,差异均有统计学意义(均P<0.05)。两组术后并发症总发生率差异无统计学意义(P>0.05)。随访期间,观察组失访1例,复发3例,共死亡5例,3年总生存率为88.24%,无事件生存率85.29%。对照组失访2例,复发9例,共死亡8例,3年总生存率81.82%,无事件生存率为66.67%,两组术后3年总生存率差异无统计学意义(P>0.05),观察组术后3年无事件生存率显著高于对照组(P<0.05)。结论头侧中间入路较常规中间入路用于直肠癌根治术有助于提升术后3年无事件生存率,前者手术时间更短且有利于彻底清扫第253组淋巴结。

Objective To study the clinical effects of laparoscopic surgery by cephalo-medial to lateral approach in the treatment of rectal cancer. Methods 70 patients with rectal cancer were randomly assigned to 2 groups,with 35 cases in each group. The treatment group received laparoscopic surgery for rectal cancer by cephalo-medial to lateral approach,and the control group traditional medialto-lateral approach. The operation time,blood loss,lymph node dissection,postoperative anal exhaust time,hospitalization time and postoperative complications were compared between the two groups. Patients were followed-up postoperatively for 3 years. The overall survival and no-event survival were compared between the two groups. Results The operation time in the treatment group was significantly lower than in the control group. Cleansing of 253 rdgroups of lymph nodes was significantly higher in the treatment group than in the control group（P〈0.05）. There was no significant difference between the two groups in the incidence of postoperative complications（P〉0.05）. During the follow-up period,1 patient in the treatment group lost follow-up and 5 patients died. The 3-year overall survival and no-event survival rates in the treatment group was 88.24% and 85.29%,respectively. In the control group,2 patients in the treatment group lost follow-up and 8 patients died. The 3-year overall survival and no-event survival rates in the control group was 81.82% and 66.67%,respectively. There was no significant difference in 3-year overall survival rates between the two groups（P〉0.05）. The 3-year no-event survival in the treatment group was significantly better than that in the control group（P〈0.05）. Conclusion Compared with traditional medial-to-lateral approach,cephalo-medial to lateral approach could shorten the operation time and enable thorough cleansing of 253 rdgroups of lymph nodes,as well as improving 3-year overall and no-event survival.