直肠癌患者的腹腔镜手术效果研究  

The effect study of minimally invasive surgery on patients with rectal cancer

作　　者：邹先雄 刘典勋 邓黎[2] 刘永安[2] 

机构地区：[1]公安县中医医院,湖北荆州434300 [2]荆州市第一人民医院

出　　处：《腹腔镜外科杂志》2015年第6期437-441,共5页Journal of Laparoscopic Surgery

摘　　要：目的:对比腹腔镜与开腹手术治疗直肠癌的手术疗效,探讨腹腔镜手术治疗直肠癌的安全性与预后。方法:选择84例直肠癌患者,其中42例行腹腔镜直肠癌根治术(观察组),42例行开腹直肠癌根治术(对照组),对比分析两组患者的手术疗效。结果:观察组与对照组的全直肠系膜切除术完成率(88.1%vs.92.9%)、保肛率(81.0%vs.76.2%)、淋巴结清扫数量[(13.2±7.6)vs.(13.6±7.8)]、肿瘤近切缘距离[(10.2±5.8)cm vs.(10.1±5.4)cm]与远切缘距离[(3.5±1.2)cm vs.(3.6±1.3)cm]差异均无统计学意义(P>0.05)。观察组手术时间长于对照组[(154.6±76.3)min vs.(122.1±57.5)min,P<0.05],但术中出血量少于对照组[(98.3±47.6)ml vs.(174.4±82.2)ml,P<0.05]。观察组患者术后住院时间[(9.2±2.3)d vs.(11.4±4.6)d]、术后排气时间[(2.6±1.1)d vs.(3.5±1.7)d]、术后进半流质饮食时间[(3.6±1.1)d vs.(4.3±1.4)d]、并发症发生率(11.9%vs.31.0%)均优于对照组,差异有统计学意义(P<0.05)。两组患者均无围手术期死亡病例。术后随访,两组患者局部复发率(2.4%vs.4.8%)及1年(83.3%vs.81.0%)、3年(78.6%vs.73.8%)生存率差异无统计学意义(P>0.05)。结论:腹腔镜全直肠系膜切除术治疗直肠癌可取得与开腹手术相同的疗效,且具有术中出血少、并发症发生率低、术后康复快的优点。Objective ：To compare the effect of laparoscopic versus open surgery for rectal cancer, in order to explore the safety and prognosis of laparoscopic surgery. Methods：Eighty-four patients with rectal cancer were divided into observer group （42 cases,lap- aroscopic surgery） and control group （42 cases, open surgery）. The clinical outcomes were comparatively analyzed between the two groups. Results：The overall completion rates of total mesorectal excision （88.1% , 37/42 vs. 92.9% ,39/42）, the rates of anus pre- serving （81.0%, 34/42 vs. 76.2% ,32/42）, the number of lymph node dissection [ （ 13.2 ± 7.6） vs. （ 13.6 ± 7.8 ） ], the distance to proximal resection margin [ （ 10.2 ± 5.8 ） cm vs. （ 10. 1 ± 5.4 ） cm ] and distal resection margin [ （ 3.5 ± 1.2 ） cm vs. （ 3.6 ± 1.3 ） cm ] were not significantly different between observer and control group （ P 〉 0.05 ）. The operative time of observer group was longer than that of control group [ （ 154.6 ± 76.3 ） min vs. （ 122.1 ± 57.5 ） min, P 〈 0.05 ], however, amount of bleeding during opera- tion was fewer than that of control group [ （98.3 ± 47.6） ml vs. （ 174.4 ± 82.2） ml, P 〈 0.05 ]. The postoperative hospital stay [ （9.2 ± 2.3 ） d vs. （ 11.4 ± 4.6） d ], time of exhausting during operation [ （2.6 ± 1.1 ） d vs. （3.5 _± 1.7 ） d ], postoperative time to intake semi-solid [ （3.6 ± 1.1） d vs. （4.3 ± 1.4） d l, and the rate of postoperative complications （11.9% ,5/42 vs. 31.0%, 13/42, P 〈 0.05 ） in observer group were lower than those of control group. There were no operative deaths in both groups. The local recurrences of observer （2.4%, 1/42） and control group （4.8% ,2/42） were not significantly different （P 〉 0.05 ）. There were no differences in 1-year （ 83.3% vs. 81.0% ） and 3-year survival rate （78.6% vs. 73.8% ） between observer group and control group （ P 〉 O. 05 ）. Conclusions ：The laparoscopic surgery with total mesorectal e

关 键 词：直肠肿瘤 腹腔镜检查 全直肠系膜切除术 

分 类 号：R735.37[医药卫生—肿瘤]