手辅助腹腔镜和腹腔镜及开腹直肠癌根治术的近期疗效比较  

Comparison of short-term outcomes of hand-assisted laparoscopic, laparoscopic, and open surgery in the treatment of rectal cancer

作　　者：鞠海星[1] 黄新[1] 朱玉萍[1] 冯海洋[1] 李德川[1] 

机构地区：[1]浙江省肿瘤医院结直肠外科,杭州310022

出　　处：《中华胃肠外科杂志》2014年第6期574-577,共4页Chinese Journal of Gastrointestinal Surgery

摘　　要：目的比较手辅助腹腔镜和腹腔镜及开腹手术3种方式应用于直肠癌根治术的近期疗效。方法回顾性分析2009年6月至2012年6月在浙江省肿瘤医院结直肠外科接受直肠癌根治术的390例患者的临床资料，其中手辅助腹腔镜组101例，腹腔镜组157例，开腹手术组132例。比较3组患者在手术时间、术中出血量、切口长度、中转开腹率、淋巴结检出数目、标本长度、下切缘长度、术后恢复排气时间、进食时间、术后住院时间及并发症等方面的差异。结果腹腔镜组手术时间为（231±61）min，明显长于手辅助腹腔镜组的（173±39）min和开腹手术组的（163±38）min（P〈0．01）。手辅助腹腔镜组与腹腔镜组的中转开腹率分别为2．0％（2／101）和3．2％（5／157），差异无统计学意义（P=0．708）。手辅助腹腔镜组、腹腔镜组和开腹手术组的术后并发症发生率分别为11．9％（12／101）、11．5％（18／157）和19．7％（26／132），差异无统计学意义（P=0．100）。3组术后标本长度、下切缘长度、清扫淋巴结数目和阳性淋巴结数目的差异无统计学意义（均P〉0．05）。手辅助腹腔镜组与腹腔镜组患者的术后排气时间、进食时间和住院时间均明显短于开腹手术组（均P〈0．01）。结论手辅助腹腔镜手术与腹腔镜手术一样具有创伤小和术后恢复快等优势．可达到与开腹手术一样的近期肿瘤根治效果，但手辅助腹腔镜手术明显缩短了手术时间。Objective The aim of this study was to compare the short-term outcomes for handassisted, laparoscopic, and open resection for rectal cancer. Methods Three hundred ninety patients with rectal cancer who underwent curative resection between June 2009 and June 2012 were included. Patients were classified into a hand-assisted group （HALS, n=101）, a laparoseopic surgery group （LS, n=157）, and an open surgery group （OS, n=132）. Patient and disease characteristics, operative parameters, postoperative morbidity, pathological results and length of recovery were compared among three groups. Results The mean operating time was （173±39） min for the HAL, S group, （231±61） min for the LS group, and （173±39） min for the OS group （P〈0.01）. Conversion ratesdid not differ between HALS and LS groups （2.0% vs 3.2%, P=0.708）. The overall complication rates were 11.9%, 11.5%, and 19.7% in the HALS, LS and OS groups respectively （P=0.100）. The specimen quality with a specimen length, distal resection margin, harvested lymph nodes, and positive lymph nodes did not differ among the three groups. Patients in the HALS and IS groups recovered significantly faster than those from the OS group. Conclusions This comparative study shows that HALS and IS can reproduce the equivalent short-term results of standard OS. HALS retained the minimal invasive advantages of LS, and significantly shorten the operation time.

关 键 词：直肠肿瘤 直肠癌根治术 开腹手术 手辅助腹腔镜手术 腹腔镜手术 

分 类 号：R735.37[医药卫生—肿瘤]