不同手术入路的腹腔镜手术治疗直肠癌的疗效及安全性

Therapeutic Effect and Safety of Laparoscopic Surgery with Different Surgical Approaches for Rectal Cancer

目的探讨不同手术入路的腹腔镜手术治疗直肠癌的疗效及安全性。方法选择接受腹腔镜手术治疗的156例直肠癌患者作为研究对象,根据入院先后顺序,采用随机数字表法分为A组和B组,各78例。A组采用头侧中间入路,B组采用传统中间入路。比较2组术后病理TNM分期、组织学分化程度,记录术中和术后主要结局指标,淋巴结清扫结果及手术相关并发症发生情况,随访12个月,观察术后生存、肿瘤复发或转移情况。结果所有患者均顺利完成手术,未见中转开腹病例,手术切缘均为阴性。在A组和B组中分别有2例(2.56%)、3例(3.85%)患者第253组淋巴结病理学检查结果显示肿瘤学阳性,2组术后病理TNM分期及组织学分化程度比较,差异无统计学意义(P>0.05)。2组术中出血量、术后肛门排气时间、住院时间比较,差异均无统计学意义(P>0.05);A组手术时间明显短于B组,差异有统计学意义(P<0.05);2组淋巴结清扫数目比较,差异无统计学意义(P>0.05);A组清扫肠系膜下动脉(IMA)周围淋巴结时间明显短于B组,第253组淋巴结清扫数目明显多于B组,差异均有统计学意义(P<0.05)。所有患者均获得随访,未见肿瘤相关死亡、复发或转移病例;2组手术相关并发症发生率比较,差异无统计学意义(P>0.05)。结论头侧中间入路的腹腔镜手术治疗直肠癌可获得与传统中间入路相当的近期疗效,安全性可靠,在手术视野暴露、进入正确解剖间隙和清扫第253组淋巴结上具有优势,值得进一步研究应用。

Objective To evaluate the efficacy and safety of laparoscopic surgery for rectal cancer with different surgical approaches.Methods 156 cases of rectal cancer treated with laparoscopic surgery were selected as subjects,according to the order of admission,they were divided into group A and group B by random number table method,78 cases each;group A adopts the middle side of the head side,group B adopts the traditional intermediate approach;the pathological TNM staging and histological differentiation were compared between the two groups,recorded the main outcome indicators during and after surgery,lymph node dissection results and surgical complications,followed up for 12 months,observed survival,tumor recurrence or metastasis.ResultsAll patients successfully completed the operation,no cases of conversion to open surgery,the surgical margins were negative,in group A and group B,2(2.56%)and 3(3.85%)patients,respectively,the 253 group of lymph node pathology showed tumorigenic positive,comparison of postoperative pathological TNM staging and histological differentiation between the two groups,difference was not statistically significant(P>0.05);the amount of intraoperative blood loss,postoperative anal exhaust time,and hospital stay were compared between the two groups,difference was not statistically significant(P>0.05);the operation time of group A was significantly shorter than that of group B,difference was statistically significant(P<0.05);there was no significant difference in the number of lymph node dissection between the two groups(P>0.05);the time of lymph node dissection around the inferior mesenteric artery(IMA)in group A was significantly shorter than that in group B,the number of lymph node dissection in group 253 was significantly higher than that in group B,differences were statistically significant(P<0.05);all patients were followed up and no tumor-related death,recurrence or metastasis was seen;there was no significant difference in the incidence of surgical complications between the two groups(P>0.05).Conclusion Laparoscopic surgery for the treatment of rectal cancer with a cephalic approach is comparable to the traditional intermediate approach,safe and reliable,it is advantageous to expose the surgical field,enter the correct anatomical space,and clean the 253th node,worth further research and application.