腹腔镜与开腹直肠癌根治术的临床对照

Clinical comparison between laparoscopic radical resection and laparotomy for rectal cancer

目的比较腹腔镜直肠癌根治术与同期开腹手术的临床疗效。方法选择2010年1月至2014年12月我院收治的170例直肠癌患者,85例行腹腔镜直肠癌根治术,85例患者同期行开腹直肠癌根治术,将腹腔镜组及开腹组的临床资料和随访资料进行分析。结果腹腔镜组术中失血量为(143.42±37.61)mL、术后肛门排气时间为(58.70±15.63)h、术后住院时间为(9.12±2.71)d,优于开腹组的(225.09±50.23)mL、(76.45±11.89)h、(12.62±3.14)d(P<0.05);腹腔镜组手术时间为(185.25±41.96)min、开腹组手术时间为(178.50±28.33)min,两组比较,差异无统计学意义(P>0.05);开腹组住院费用为(3.76±0.32)万元,优于腹腔镜组的(4.53±0.61)万元(P<0.05);腹腔镜组术后肠梗阻发生率为2.35%,优于开腹组的5.88%(P<0.05),腹腔镜组吻合口瘘发生率为9.41%、切口感染率为4.71%,与开腹组的8.23%、5.88%比较,差异无统计学意义(P>0.05)。Kaplan-Meier分析显示,术后3、5年生存率腹腔镜组分别为62.75%、56.32%,开腹组分别为63.83%、54.55%,两组比较,差异无统计学意义(P>0.05)。结论腹腔镜直肠癌根治术具有较好的安全性及可行性,在有腹腔镜手术基础的医院可优先选择。

Objective To compare the clinical efficacy between laparoscopic radical resection and laparotomy for rectal cancer.Methods A total of 170 patients with rectal cancer treated in our hospital from January 2010 to December 2014 were selected.85 patients underwent laparoscopic radical resection of rectal cancer and 85 patients underwent laparotomy of rectal cancer at the same time.The clinical data and follow-up data of laparoscopic group and laparotomy group were analyzed.Results The intraoperative blood loss,postoperative anal exhaust time and postoperative hospital stay in laparoscopic group were(143.42±37.61)mL,(58.70±15.63)h and(9.12±2.71)d,respectively,which were better than those in laparotomy group([225.09±50.23]mL,[76.45±11.89]h and[12.62±3.14]d)(P<0.05).The operation time of laparoscopic group was(185.25±41.96)min and that of laparotomy group was(178.50±28.33)min,there was no significant difference between the two groups(P>0.05)The hospitalization cost of laparotomy group was(3.76±0.32)ten thousand yuan,less than(4.53±0.61)ten thousand yuan of laparoscopic group(P<0.05).The incidence of postoperative intestinal obstruction in laparoscopic group was 2.35%,which was better than that in laparotomy group(5.88%)(P<0.05).The incidence of anastomotic leakage and incision infection rate in laparoscopic group was 9.41%and 4.71%,and that of laparotomy group was 8.23%and 5.88%,respectively,with no significant difference(P>0.05).Kaplan-Meier analyses showed that the 3-year and 5-year survival rates were 62.75%and 56.32%respectively in laparoscopic group and 63.83%and 54.55%respectively in laparotomy group,and there was no significant difference between the two groups(P>0.05).Conclusion Laparoscopic radical resection of rectal cancer is safe and feasible,which can be preferred in laparoscopic surgery.