腹腔镜与开腹手术治疗低位直肠癌的临床对比研究

Laparoscopic and Open Total Mesorectal Excision in the Treatment of Low Rectal Cancer:a Clinically Comparative Study

为对比分析腹腔镜和开腹全直肠系膜切除术治疗低位直肠癌的临床疗效,选取2013年1月至2015年10月本院收治的130例低位直肠癌患者。根据手术方式分为观察组和对照组,各65例。观察组行腹腔镜全直肠系膜切除术,对照组行开腹全直肠系膜切除术,观察比较2组患者手术相关指标、并发症发生情况及预后指标。结果显示,观察组保肛率为75.4%(49/65),对照组保肛率为53.8%(35/65),差异有统计学意义(P<0.05);观察组手术时间为(178.5±24.3)min,高于对照组(121.4±26.9)min;观察组术后出血量(124.6±18.5)mL,胃肠功能恢复时间(1.2±0.8)d以及住院时间(17.8±2.5)d均显著低于对照组的(220.3±15.7)mL,(2.9±1.3)d和(20.1±3.7)d(P<0.05);观察组术后并发症发生率为16.9%,明显低于对照组32.3%,差异有统计学差异(P<0.05);随访8~24个月,观察组局部复发率、远处转移率以及术后2年生存率与对照组比较,无显著性差异(P>0.05)。结果表明,与开腹全直肠系膜切除术相比,腹腔镜全直肠系膜切除术治疗低位直肠癌术后恢复快,并发症少,安全性良好,临床疗效与开腹手术相当。

This study was to compare and analyse the clinical effect of low rectal cancer treated with laparoscopic total mesorectal excision(L-TME)and open total mesorectal excision(O-TME),enrolled 130 cases received treatment in author’s hospital(2013-01-2015-10)and according to different operation methods divided them into observation group(65 cases,L-TME)and control group(65 cases,O-TME),then compared relevant operative norms,prognosis norms and complication incidence between the two groups.As results,in anus-saving rate,in operative time,in post-operative bleeding volume,in the time of gastrointestinal function recovered and of hospitalization,and in postoperative complication incidence observation group was respectively and significantly higher,longer,less,shorter and lower than control group,there was statistical difference between the two groups[75.40%(49/65)vs 53.8%(35/65),P <0.05],[(178.5±24.3)min vs(121.4±26.9)min,P <0.05],[(124.6±18.5)mL vs(220.3±15.7)mL,P <0.05],[(1.2±0.8)d vs(2.9±1.3)d,P <0.05,(17.8±2.5)d vs(20.1±3.7)d,P <0.05]and[(16.9%vs 32.3%,P <0.05)];but the follow-up of 8-24 months did not find significant difference in local recurrence rate,distant metastasis rate and the survival rate 2 years latter after surgery between the two groups(P >0.05).Results show that compared with O-TME,L-TME has more advantages as fast postoperative recovery,less complication,better safety,the clinical effect is similar to that of laparotomy.