腹腔镜与开腹低位直肠癌全直肠系膜切除术的前瞻性随机对照研究  

Laparoscopic vs.Open Total Mesorectal Excision for Low Rectal Cancer: Randomized Controlled Trial

作　　者：张键[1] 骆成玉[1] 季晓昕[1] 杨齐[1] 林华[1] 周永桥[1] 段煜飞[1] 

机构地区：[1]首都医科大学附属复兴医院普外科,北京100038

出　　处：《中国微创外科杂志》2012年第1期27-29,共3页Chinese Journal of Minimally Invasive Surgery

摘　　要：目的探讨腹腔镜下低位直肠癌全直肠系膜切除术(total mesorectal excision,TME)的可行性。方法 2005年1月～2008年1月将71例Duke’s A、B期的低位直肠癌,按照序贯原则设计,采用信封抽签法随机分为2组,分别施行腹腔镜和开腹TME,比较2组患者围手术期及术后随访情况。结果腹腔镜组手术时间(116.9±20.7)min显著短于开腹组(133.6±20.0)min(t=-3.456,P=0.000),术中出血量(84.4±27.6)ml显著少于开腹组(145.7±34.0)ml(t=-8.349,P=0.000),术后肠功能恢复时间(2.6±1.0)d显著短于开腹手术组(4.0±1.0)d(t=-5.898,P=0.000),淋巴结清扫数目2组间无显著性差异[(12.2±3.0)枚vs.(12.3±2.6)枚(t=-0.127,P=0.899)]。腹腔镜手术组保肛率明显高于开腹手术组[83.3%(30/36)vs.60.0%(21/35),χ2=4.775,P=0.029]。71例随访24～60个月,中位随访40个月,2组局部复发各1例,远处转移各2例,差异无统计学意义(χ2=0.000,P=1.000;χ2=0.000,P=1.000)。结论 腹腔镜下低位直肠癌TME治疗低位直肠癌是安全可行的。Objective To evaluate the feasibility of laparoscopic total mesorectal excision（TME） for low rectal cancer.Mothods Totally 71 patients with low rectal cancer（Duke＇s A or B） were randomly assigned to laparoscopy（n=36） or open surgery group（n=35）.Peri-operative indexes and results of postoperative follow-up were compared between the two groups.Results Compared to the open surgery group,the laparoscopy group had significantly shorter mean operation time [（116.9±20.7） min vs.（133.6±20.0） min,t=-3.456,P=0.000],less blood loss [（84.4±27.6） ml vs.（145.7±34.0） ml,t=-8.349,P=0.000],shorter gastrointestinal recovery time [（2.6±1.0） d vs.（4.0±1.0） d,t=-5.898,P=0.000],and higher rate of sphincter-preservation [83.3%（30/36） vs.60.0%（21/35）,χ2=4.775,P=0.029].No significant difference existed in the number of resected lymph notes between the two groups（12.2±3.0 vs.12.3±2.6,t=-0.127,P=0.899）.The patients were followed up for 24-60 months with a median of 40 months,during which,there was one patient in each group showing local recurrence,and two patients in each group had distant metastasis（χ2=0.000,P=1.000;χ2=0.000,P=1.000）. ConclusionLaparoscopic TME is feasible and safe for low rectal cancer.

关 键 词：低位直肠癌 全直肠系膜切除术 腹腔镜手术 

分 类 号：R735.37[医药卫生—肿瘤]