结直肠癌患者腹腔镜根治术与开腹手术疗效比较

A comparison of laparoscopic and open surgery for colorectal cancer

目的比较腹腔镜与开腹手术治疗结直肠癌患者的临床疗效。方法回顾性分析2014年4月~2018年12月期间收治的行结直肠癌根治术的98例患者的临床资料,其中腹腔镜结直肠癌根治术患者51例(LAP组),开腹结直肠癌根治术患者47例(OPEN组),对比两组患者手术时间、术中出血量、淋巴结清扫数、术后进食时间、术后排气时间和术后住院天数、术后并发症等临床资料。结果LAP组手术时间(177.76±26.69)min,与OPEN组(180.06±26.97)min比较,差异无统计学意义(t=-0.217,P=0.673);LAP组术中出血量(83.33±28.26)ml,少于OPEN组(116.60±31.37)ml,差异有统计学意义(t=-1.192,P<0.001);LAP组淋巴结清扫数(14.55±2.60),与OPEN组(14.79±3.09)比较差异无统计学意义(t=-1.336,P=0.680);LAP组术后排气时间为(64.22±11.73)h,与OPEN组(68.98±11.90)h比较差异有统计学意义(t=-2.115,P=0.040);LAP组术后进食时间为(78.33±13.37)h,与OPEN组进食时间(86.87±12.59)h比较差异有统计学意义(t=-0.222,P=0.002);LAP组术后发生肺部感染1例、肠漏3例、肠梗阻3例,OPEN组术后发生肺部感染2例,切口感染2例、肠漏3例、肠梗阻1例;两组术后并发症发生率为13.7%(7/51)和17.0%(8/47),差异无统计学意义(χ^2=0.205,P=0.651)。LAP组术后住院时间为(9.20±2.22)d,与OPEN组(10.51±2.10)d比较差异有统计学意义(t=-0.554,P=0.003)。结论腹腔镜结直肠癌根治术是一种安全可行微创术式,与开腹手术比较具有术中出血少、术后恢复快的优点。

Objective To compare the clinical effects of laparoscopy and operation in the treatment of colorectal cancer.Methods Clinicopathological data of 98 cases with radical rectectomy and colectomy for colorectal cancer from April 2014 to December 2018 were retrospectively analyzed.These cases were non-randomly divided into laparoscopic group(LAP)including 51 cases and open surgery group(OPEN)including 47 cases,respectively.The surgical duration,blood loss and postoperative recovery were compared.Results The surgical duration of laparoscopic group(177.76±26.69)min had no significant difference compared with open group(180.06±26.97)min(t=-0.217,P=0.673).The amount of blood loss of laparoscopic group(83.33±28.26)ml was less than that of the open group(116.60±31.37)ml,with significant difference(t=-1.192,P<0.001).There was no statistical difference of the number of cleared lymph nodes between two groups(14.55±2.60)pieces vs.(14.79±3.09)pieces(t=-1.336,P=0.680).The exhaustion duration of laparoscopic group(64.22±11.73)h was less than that of the open group(68.98±11.90)h,with significant difference(t=-2.115,P=0.040).The eating time of laparoscopic group(78.33±13.37)h was less than that of the open group(86.87±12.59)h,with significant difference(t=-0.222,P=0.002).After laparoscopic surgery,there were 1 case of lung infection,3 cases of colonic fistula,and 3 cases of intestinal obstruction;whereas after open surgery,there were 2 cases of lung infection,2 cases of inclusion infection,3 cases of colonic fistula,and 1 case of intestinal obstruction.The complication rates were13.7%(7/51)and 17.0%(8/47)respectively,without significant difference(χ^2=0.205,P=0.651).The hospital stay of laparoscopic group(9.20±2.22)d was shorter than that of open group (10.51±2.10)d,with significant difference(t=-0.554,P=0.003).Conclusion Laparoscopic operation in the treatment of colorectal cancer has no significant difference in clinical effects compared with open operation,bearing advantages of less blood loss and quick recovery.