腹腔镜与开腹完整结肠系膜切除术164例的临床对比研究

Clinical comparison between laparoscopic and open complete mesorectal excision of 164 cases with colon cancer

目的探讨腹腔镜与开腹结肠癌完整结肠系膜切除术(complete mesorectal excision,CME)在术后恢复、手术质量及中期疗效方面的差异。方法收集滨州医学院附属淄博市中心医院腹腔镜外科2010年12月至2014年9月间实施的164例结肠癌CME手术患者的临床资料。其中腹腔镜手术组92例,开腹手术组72例,比较两组患者的术后恢复、肿瘤根治性、术后感染发生率及中期复发率方面的差异。结果腹腔镜组在术中出血量、术后排气时间、术后下床时间、切口感染率方面均优于开腹手术组,两组患者的近端切缘、远端切缘长度及淋巴结清扫数目的差异均无统计学意义(P>0.05),两组患者在手术时间方面无统计学差异(P>0.05)。164例患者中,有134例(81.7%)接受了术后随访,中位随访时间21个月。腹腔镜组与开腹组的局部复发率分别为4.3%(4/92)和4.2%(3/72),差异均无统计学意义(P>0.05)。结论腹腔镜结肠癌CME手术较开腹手术能显著缩短患者术后恢复时间,且能达到与开腹手术相同的肿瘤根治范围,中期复发率于开腹手术相当,有良好发展前景。

Objective To explore the difference between laparoscopic and open complete mesorectal excision(CME)for colon cancer on postoperative recovery、surgical quality and interim outcome.Methods During December 2010 to September 2014, 164 cases of colon cancer were included in Laparoscopic Department of Zibo Central Hospital affiliated to Binzhou Medical college,of which 92 patients were assigned to laparoscopic CME and 72 to laparotomy open procedure.Surgical quality, postoperative recovery、postoperative infection,the degree of cancer radical resection, and interim outcome were compared between the two groups.Results 134(81,7%) out of 164 patients received follow-up,with a median time of 21 months.The differences of proximal and distal surgical margin length, number of lymph nodes dissection, surgical time and local tumor recurrence rates(4.3% and 4.2%) were not statistically significant(P >0.05),but laparoscopic CME were better than the laparotomy open group in the blood loss、time of flatus passage, bed time and incision infection rates.Conclusion Compared to laparotomy open CME, Laparoscopic CME can significantly shorten the time of postoperative recovery and achieve the same range of cancer radical resection and has a broad application prospect.