腹腔镜中低位直肠癌根治保肛手术与传统开腹手术的比较研究

摘要

目的 评价腹腔镜中低位直肠癌根治保肛手术的可行性、安全性以及近期临床效果.方法 回顾性分析南华大学附属第二医院2014年3月至2016年3月收治的84例中低位直肠癌病人临床资料,其中腹腔镜组46例,开腹组38例.对两组病人短期疗效、造口比率、术后肛门功能、复发率及存活率进行比较.结果 腹腔镜组与开腹组相比,切口长度短[(6.8±1.1) cm比(16.0±1.4)cm,P＜0.01],术中出血少[(58.8±11.6) ml比(120.3±13.9) ml,P＜0.01],术后肠道功能恢复时间短[(1.7±0.7)d比(3.5±1.1)d,P＜0.01],术后住院时间短[(10.2±3.1)d比(15.1±2.6)d,P＜0.01],切口感染发生率低[2.2％比15.8％,P＜0.01],但手术时间稍长[(172.0±16.2) min比(141.0±12.1)min,P＜0.01].两组在造口比率[19.6％比18.8％]、切除标本长度[(18.7±1.2)cm比(18.1±1.0)cm]、清除的淋巴结数量[(16.0±2.2)枚比(16.3±2.9)枚]及其他并发症发生率上差异均无统计学意义(均P＞0.05).术后12个月,腹腔镜组病人肛门功能正常率达94.1％,开腹组为94.7％,两组差异无统计学意义(P＞0.05).术后平均随访12个月,腹腔镜组和开腹组,局部复发率分别为4.3％和5.2％,总生存率均为100％,差异均无统计学意义(P＞0.05).结论 腹腔镜中低位直肠癌根治保肛术安全、可行、有效.%Objective To evaluate the feasibility,safety,and the recent clinical effects of laparoscopic anus-preserving radical resection of lower rectal cancer.Methods From Mar.2014 to Mar.2016,84 patients with lower rectal cancer were retrospectively analyzed.A total of 46 cases were treated with laparoscopic-assistedtotalmesorectal excision (LTME group),and 38 cases were treated with conventional open total mesorectal excision (OTME group).The short-term outcomes,postoperative anal function,local recurrence and survival rate were evaluated.Results LTME had significantly shorter length of incision[(6.8± 1.1) cm vs.(16.0 ± 1.4)cm,P＜0.01],less intra-operative blood loss [(58.8 ± 11.6)mL vs.(120.3 ± 13.9)mL,P＜0.01],shorter postoperative bowel function recovery time[(1.7±0.7)days vs.(3.5 ± 1.1)days,P＜0.01],shorter postoperative hospital stay[(10.2±3.1)daysvs.(15.1 ±2.6)days,P＜0.01] and lower incidence of wound infection (2.2％ vs.5.8％,P＜0.01),however longer operation time [(172.0 ± 16.2)min vs.(141.0 ± 12.1)min,P＜0.01]than OTME.There was no significant difference in thecolostomyrate (19.6％ vs.18.8％,P＞0.05),length of resected specimen [(18.7 ± 1.2)cm vs.(18.1 ± 1.0) cm,P＞0.05],number of harvested lymph nodes[(16.0 ± 2.2) vs.(16.3 ± 2.9),P＞0.05] and incidence of other complications between two groups.Twelvemonths after surgery,94.1％ patients in LTME group and 94.7％ patients in OTME group achieved normal analfunction and there was no significant difference between two groups (P＞0.05).The patients were followed for an average of 12 months.The local recurrence was 4.3％in LTME group and 5.2％ in OTME group,and survival rate was 100％ in two groups (P＞0.05).Conclusions Laparoscopic anus-preserving radical resection of lower rectal canceris safe,feasible and effective.