中晚期直肠癌腹腔镜TME手术的疗效评价

Efficacy of laparoscopic total mesorectal excision in the treatment of advanced rectal cancer

目的评价腹腔镜下全直肠系膜切除术(TME)治疗中晚期直肠癌的临床疗效。方法选择2013年4月至2016年6月65例中晚期直肠癌患者进行回顾性分析,根据手术方式的不同,将患者分为开腹组(34例)和腹腔镜组(31例),均行TME手术治疗。应用SPSS 20.0软件进行统计学分析,围术期指标等以(x±s)形式表示,组间比较采用独立样本t检验;术后并发症发生情况及生存率等采用χ~2检验;P<0.05为差异有统计学意义。结果腹腔镜组术中出血量、手术时间、术后初次下床时间均低于开腹组,差异有统计学意义(P<0.05);两组术后初次排气时间、远切端距离、淋巴结清扫数量和系膜完整率对比,差异无统计学意义(P>0.05)。术后,腹腔镜组并发症发生率为3.2%(1/31),低于开腹组的20.6%(7/34),差异有统计学意义(P<0.05);两组术后1年生存率对比,差异无统计学意义(P>0.05)。结论腹腔镜下TME在中晚期直肠癌患者临床治疗中疗效显著,其保障治疗效果的同时更具有微创性,可减少术中出血量及手术时间,降低术后并发症发生风险,利于患者术后尽早恢复,值得积极应用推广。

Objective To evaluate the effect of laparoscopic total mesorectal excision in the treatment of advanced rectal cancer. Methods A total of 65 patients with advanced rectal cancer were enrolled in our hospital from April 2013 to June 2016 as subjects. The patients were divided into the open group （34 cases） and laparoscopic group （31 cases）. All patients were treated with TME operation. Statistical analysis was performed by using SPSS20.0, the perioperative index were presented as （x ± s） and examined by t test; the occurrence of postoperative complications and survival rate were examined by chi square. A P value of 〈 0.05 was considered as significant difference. Results The blood loss, time of operation, time of getting out of bed in laparoscopic group was lower than that in open group, the difference was statistically significant （P 〈 0.05 ）. There were no significant difference in the initial exhaust time, the rectum to the inferior margin of the turner, the number of lymph nodes scavenged and the mesangial integrity rate between the two groups （P 〉 0.05 ）. The overall incidence of intestinal obstruction, anastomotic fistula, urinary retention and surgical incision infection （3. 2%, 1/31 ） were lower than that in open group （20.6% , 7/34 ）, the difference was statistically significant （P 〈0. 05 ） ; There was no significant difference in survival rate between the two groups in one year after operation （P 〉 0.05）. Conclusion Laparoscopic total mesorectal excision in the treatment of patients with advanced rectal cancer has a same curative effect, better minimally invasive effect , which is helpful to patient＇ s recovery and worth promoting.