腹腔镜下直肠癌根治术与开腹手术围手术期疗效分析  

Perioperative efficacy on radical resection of rectal carcinoma： a compara- tive analysis of laparoscopy with open approach

作　　者：李俊韬[1] 洪楚原[1] 邹湘才[1] 邓一文[1] 梁国健[1] 林健生[1] 张继民[1] 

机构地区：[1]广州医学院第二附属医院胃肠外科,广州510260

出　　处：《国际外科学杂志》2011年第10期666-671,共6页International Journal of Surgery

摘　　要：目的比较腹腔镜下直肠癌根治术与传统开腹手术围手术期的疗效与安全性，评价腹腔镜下直肠癌根治术的可行性、安全性和肿瘤根治性。方法收集整理广州医学院第二附属医院胃肠外科开展腹腔镜下直肠癌根治术的44例临床资料，包括手术相关指标、术后恢复指标、肿瘤根治性指标、术中术后并发症等数据，进行统计学分析，并与同期53例传统开腹手术进行比较，评估两种手术方式围手术期疗效的差异性。结果腹腔镜组与开腹组的手术时间分别为（260．45±67．46）min和（179．25±40．92）min，术中出血量分别为（125．20±61．80）mL和（198．60±131．24）mL，差异具有统计学意义（P〈0．05）。术后肠道排气：腹腔镜组为（2．6±0．9）d，开腹组为（3．1±1．1）d；进食时间：腹腔镜组为（3．64-1．0）d，开腹组为（4．3±1．1）d；患者离床活动时间：腹腔镜组为（4．4±1．6）d，开腹组为（5．5±I．6）d，差异均有统计学意义（P〈0．05）。且腹腔镜组的腹腔引流管及尿管保留时间均明显少于歼腹组，差异具有统计学意义（P〈0．05）。而手术中腹腔镜组输血患者4例，开腹组8例；术后腹腔镜组发生并发症5例，开腹组11例；术后住院天数分别为（15．34±6．62）d和（16．82±5．73）d，差异无统计学意义（P〉0．05）。术后检查切除肠管长度、肿瘤距远端距离和淋巴结摘除个数等指标，2组标本差异均无统计学意义（P〉0．05）。结论与开腹手术相比，腹腔镜下直肠癌根治术在围手术期具有微创、出血少、患者术后疼痛减轻、胃肠膀胱功能恢复快、下床早等优势，同时能减少术后并发症及缩短术后住院时间，但手术时间长于开腹组。虽然围手术期效果与开腹组无明显差异，但是远期疗效有待进一步随访追踪。Objective To compare the efficacy of the radical resection by laparoscopy versus open approach in perioperative period on the patients with rectal carcinoma, and investigate the feasibility, safety and oneological clearance of the laparoscopy. Methods The clinical data of 44 patients who underwent radical resection of rectal carcinoma by laparoscopy in our hospital were reviewed and compared with another 53 patients who underwent an open approach in the same period. The surgery-related data, postoperative recovery status, tumor radical resection index, and postoperative complications by laparoscopy were analyzed by statistics, and compared with those by open approach, and evaluated the deference of too kinds of operation. Results This study showed a longer surgical time （260.45 ± 67.46 ） min vs （ 179.25 ± 40.92） min, P 〈 0.05, a less intra-operative blood loss （ 125.20 ± 61.80） mL vs （ 198.02 ± 131.24） mL, P 〈 0. 05, in laparoscopic group compared with open approach. Meanwhile, it also showed an earlier recovery of bowel functions for discharge gas from anus, taking in food, and out-of-bed activity （4.34 ± 1.55） d vs（5.45 ± 1.55） d, P 〈 0.05, in the laparoscopic group compared with open approach. There was no statistical difference of incidence of post-operative complications （ 5 cases vs 11 cases, P 〉 0.05 ） between the two groups and the laparoscopic approach was also equal to the open approach as regard to post-operative stay （15.34 ± 6.62 ） d vs （ 16.82 ±5.73） d, P 〉 0.05, and demand of intra-operative blood transfusion （4 case vs 8 cases, P 〉 0. 05 ）. Conclusions Compared with open surgery, the radical resection of rectal carcinoma by laparoscopy has shown obvious advantages in smaller incision, less blood loss, less pain, earlier recovery of bowel and bladder functions, and earlier out-of-bed activity. And it is also possible by laparoscopy approach to decrease the post-operative complications and post-operative stay. Meanwhile, there is no signifi

关 键 词：直肠癌 腹腔镜 开腹手术 围手术期 

分 类 号：R735.37[医药卫生—肿瘤]