腹腔镜与开腹全直肠系膜切除术治疗中低位直肠癌的同期临床对照研究  

Laparoscopic versus open total mesorectal excision for the middle-lower rectal caner： a clinical comparative study

作　　者：余江[1] 张策[1] 王亚楠[1] 胡彦锋[1] 程侠[1] 李国新[1] 

机构地区：[1]南方医科大学南方医院普通外科,广州510515

出　　处：《中华胃肠外科杂志》2009年第6期573-576,共4页Chinese Journal of Gastrointestinal Surgery

基　　金：广东省科技计划项目（2006812901006）;广州市科技攻关项目（2006Z3-E0571）

摘　　要：目的评价腹腔镜全直肠系膜切除术（TME）治疗中低位直肠癌的可行性、安全性、根治性及近期临床疗效。方法回顾性分析2005年11月至2008年10月同期收治进行TME的腹腔镜手术（93例）和传统开腹手术（105例）中低位直肠癌患者的临床资料，对两组的手术方式、手术学指标、肿瘤学指标和近期疗效进行比较。结果两组患者的临床资料具有可比性（P〉0．05）。腹腔镜组和传统开腹组手术时间分别为（164．6±35．6）min和（141．9±29．4）min；术中出血量分别为（51．4＋±20．2）ml和（180．0±64．7）ml，差异有统计学意义（P〈0．001）；腹腔镜组有4例（4．3％）中转开腹，两组保肛率差异无统计学意义（P〉0．05）；均无手术死亡。在切除标本长度、清扫淋巴结数量和肠管远切缘长度方面两组比较，差异无统计学意义（P〉0．05）：所有标本远切缘病理学检查均为阴性。腹腔镜组的术后镇痛需求率、肠功能恢复时间、进食流质时间、下床活动时间及住院时间均低于或少于开腹组（P〈0．001）；手术并发症发生率两组差异无统计学意义（P〉0．05）。平均随访19个月．腹腔镜组和开腹组患者复发率和总生存率分别是4．4％和7．3％，97．8％和97．9％．差异均无统计学意义（P〉0．05）。结论腹腔镜TME具有明显的微创优势．安全可行。Objective To evaluate the feasibility, safety, radicality and short-term outcome of laparoscopic total mesorectal excision （TME） in comparison with open procedure for the middle-lower rectal cancer. Methods From November 2005 to October 2008, 93 patients with middle-lower rectal cancer received laparoscopic total mesorectal excision（LTME group）, while 105 patients underwent conventional open TME （OTME group）. The operative procedures, clinicopathological data and short-term outcome were collected and compared between the 2 groups. Results （ 1）Comparison of surgical procedures. The demographic data of LTME and OTME groups were comparable （P〉0.05）. Four （4.3%）patients were converted to open procedure in LTME group. The anal sphincter preserved procedure accounted for 82.8% in LTME group and 81.9% in OTME group. The difference was not significant （P〉0.05）. （2）Comparison of perioperative surgical data. The mean operating time was （164.6±35.6） min in LTME group, significantly longer than that in OTME group（141.9±29.4） rain （P〈0.001）. The operative blood losses were （51.4±20.2） ml and（180.0±64.7） ml in LTME and OTME group respectively, the difference was significant（P〈0.001）. The analgesia requirement, time for bowel movement retrieval, time to liquid food intake, time to resuming early activity and hospital stay in LTME group were significant lower or shorter than those in OTME group （P〈0.001）. There was no operative death in both groups.（3）Comparison of operative complications. The overall morbidity rate was 11.8% in LTME group,and 12.4% in OTME group, the difference was not significant （P〉0.05）. The major complications were equivalent between two groups. （4）Comparison of specimen. No significant differences were observed between two groups in terms of specimen length, lymph node harvest and negative distal margin. （5）Follow-up results. The mean follow-up time was 19 months. The recurrent rate and overall survival rate were 4.

关 键 词：直肠肿瘤 腹腔镜 全直肠系膜切除术 

分 类 号：R735[医药卫生—肿瘤]