腹腔镜与开腹Dixon手术治疗直肠癌的比较

Comparative Study Between Laparoscopic and Open Dixon Surgery for Rectal Cancer

目的探讨腹腔镜Dixon手术治疗直肠癌的疗效。方法回顾性分析我院2012年1月~2014年10月腹腔镜Dixon手术50例资料,与同期开腹Dixon手术48例进行比较,并随访Karnofsky功能状态评分、生存和复发情况。结果与开腹组相比,腹腔镜组手术时间长[(194. 4±23. 4) min vs.(152. 0±19. 3) min,t=9. 765,P=0. 000],但术中出血少[(134. 7±24. 9) ml vs.(355. 2±32. 2) ml,t=-38. 012,P=0. 000],术后疼痛轻[术后1 d疼痛评分(4. 1±1. 1)分vs.(5. 9±1. 6)分,t=-6. 173,P=0. 000],排气早[(3. 8±1. 0) d vs.(4. 4±1. 7) d,t=-2. 127,P=0. 037],住院时间短[(10. 8±2. 1) d vs.(17. 3±3. 3) d,t=-11. 606,P=0. 000],并发症少[12. 0%(6/50) vs. 29. 2%(14/48),χ^2=4. 443,P=0. 035]。术后6个月、12个月腹腔镜组Karnofsky功能状态评分均高于开腹组[(86. 0±7. 8)分vs.(81. 3±9. 1)分,t=2. 768,P=0. 007;(84. 2±9. 7)分vs.(79. 8±10. 0)分,t=2. 215,P=0. 029]。2组分别随访(25. 8±3. 9)、(25. 2±3. 8)月(t=0. 682,P=0. 497),复发转移率、生存率无统计学差异[12. 0%(6/50) vs. 8. 3%(4/48),χ^2=0. 071,P=0. 790;92. 0%(46/50) vs.91. 7%(44/48),χ^2=0. 000,P=1. 000]。结论腹腔镜Dixon手术与开腹手术的疗效相当,但术后恢复快,并发症少。

Objective To explore the therapeutic effective of laparoscopic Dixon surgery for rectal cancer. Methods A total of 50 cases of laparoscopic Dixon surgery and contemporaneous 48 cases of open Dixon surgery from January 2012 to October 2014 were retrospectively analyzed. The Karnofsky Performance Score (KPS), local recurrence and distant metastases rate, and survival rate were compared. Results As compared with the open group, the laparoscopic group showed longer operation time [(194.4±23.4) min vs.(152.0±19.3) min, t =9.765, P =0.000], but less intraoperative hemorrhage [(134.7±24.9) ml vs.(355.2±32.2) ml, t =-38.012, P =0.000], lower postoperative pain scores [(4.1±1.1) points vs.(5.9±1.6) points, t =-6.173, P =0.000], earlier exhaust time [(3.8±1.0) d vs.(4.4±1.7) d, t =-2.127, P =0.037], shorter hospitalization time [(10.8±2.1) d vs.(17.3±3.3) d, t =-11.606, P =0.000], and less complications [12.0%(6/50) vs. 29.2%(14/48),χ^2 =4.443, P =0.035]. The KPS of the laparoscopic group was higher than that of the open group after 6 and 12 months [(86.0±7.8) points vs.(81.3±9.1) points, t =2.768, P =0.007;(84.2±9.7) points vs.(79.8±10.0) points, t =2.215, P =0.029]. Follow-ups were conducted for (25.8±3.9) months in the laparoscopic group and (25.2±3.8) months in the open group, respectively ( t =0.682, P =0.497). The recurrence and metastasis rate and survival rate had no statistical significance [12.0%(6/50) vs. 8.3%(4/48),χ^2 =0.071, P =0.790;92.0%(46/50) vs. 91.7%(44/48),χ^2 =0.000, P =1.000]. Conclusion Laparoscopic Dixon surgery is equivalent of open abdominal surgery, but the postoperative recovery is rapid and the complication rate is low.