腹腔镜辅助TME与开腹TME治疗超低位直肠癌的临床效果分析

Clinical efficacy of laparoscopic-assisted and openTME in the treatment of ultra-low rectal cancer

目的比较腹腔镜辅助和传统开腹方式行全直肠系膜切除术(TME)在超低位直肠癌患者中的治疗效果,评价两种手术方式的安全性和可行性。方法回顾性分析2012年8月至2014年8月间72例超低位直肠癌患者资料,行腹腔镜TME(腹腔镜组)与开腹TME手术(开腹组),各36例;采用SPSS 19.0软件分析,手术相关指标等计量资料用x±s表示,采用t检验;术后并发症及生存情况采用χ2检验;以P<0.05为差异有统计学意义。结果 72例患者手术均符合肿瘤根治性切除标准。腹腔镜组在术中平均出血量,腹壁切口长度,术后排气时间和住院时间指标上均优于开腹组(P<0.05);两组在大体标本长度、淋巴结清扫数目、远端切缘长度、环周切缘阳性数差异均无统计学差异(P>0.05);腹腔镜组患者并发症总发生率16.7%,明显低于开腹组47.2%,又以切口感染减少最为明显,差异具有统计学意义(χ2=7.730,P<0.05)。结论腹腔镜辅助超低位直肠癌手术在治疗上可达到与开腹手术相同的根治效果,且具有自身的优势,安全可靠,故经术前评估后对超低位直肠癌患者可以选择腹腔镜手术治疗。

Objective To compare the clinical outcomes between laparoscopic-assisted total mesorectal excision （ TME ） and open TME in order to evaluate the feasibility and safety in patients with ultra-low rectal cancer . Methods From August 2012 to August 2014, 72 low-rectal cancer patients were collected retrospectively , 36 cases were given laparoscopic anterior resection n TME （ L-AR/TME ） and 36 cases were given open anterior resection in TME respectively .Using SPSS 19.0 software, operation related indicators data showed with x-±s were analysed by t test and the postoperative complications and survival condition were measured in chi-square test , from which the difference had statistically significant in P〈0.05. Results All of the 72 patients were consistent with tumor standard radical excision surgery .Compare to the open group, the average intraoperative blood loss , length of incision, postoperative exhaust time and hospital stay on indicators in laparoscopic group were better （ P〈0.05）; There were no significant difference in the gross specimen length , number of lymph node cleaning , distal cutting edge length and circumferential cutting edge positive number （P〉0.05） between the two groups.The total incidence of complications in laparoscopic group was 16.7%, which was significantly lower than that in the open group （47.2%）, meanwhile the incision infection reduced obviously , the difference was statistically significant （χ2 =7.730, P 〈0.05）. Conclusions The laparoscopic resection can achieve the same clinical effect as the open surgery and it is feasible and safe , which can be a good choice for patients with ultra-low rectal cancer .