单中心腹腔镜与开腹直肠癌根治术近远期临床疗效对比研究  

Comparison on the short-and long-term clinical efficacy between laparoscopic and open radical resection of cectal rancer in a single centre

作　　者：黄跃明[1,2] 张信华 陈剑辉[1] 陈创奇[1] 

机构地区：[1]中山大学附属第一医院胃肠外科中心结直肠外科,广州510080 [2]中山市人民医院普外科

出　　处：《中华普通外科学文献（电子版）》2017年第5期298-304,共7页Chinese Archives of General Surgery(Electronic Edition)

基　　金：广东省科技计划项目(2009B030801144、2010B080701106、2013B021800131)

摘　　要：目的比较腹腔镜与开腹直肠癌根治术的近远期疗效,探讨腹腔镜直肠癌手术的可行性、肿瘤学安全性及优缺点。方法回顾性分析2008年1月至2014年12月收治的949例直肠癌病例,根据手术方式不同分为腹腔镜组(行腹腔镜下直肠癌根治术)以及开腹组(行开腹直肠癌根治术),对比两组患者的临床基本资料、手术相关数据、肿瘤病理学结果和术后随访情况并行统计学分析。结果 (1)腹腔镜组394例,开腹组555例,两组在临床基本资料上差异无统计学意义。(2)腹腔镜组在术中出血量、预防性肠造口率、术后肛门恢复排气和排便时间、拔除腹腔引流管时间、术后住院天数和总住院天数少于开腹组,而手术时间和住院总费用则高于开腹组,差异均有统计学意义(P<0.05);腹腔镜组除术中大出血发生率低于开腹组外,在总并发症发生率和其他各并发症发生率上与开腹组相当。(3)两组在肿瘤病理学方面差异无统计学意义。(4)两组在术后肿瘤复发情况,3、5年无瘤生存率和总生存率上差异均无统计学意义,两组p TNM分期亚组分析显示远期生存情况差异亦无统计学意义。结论腹腔镜下直肠癌根治术安全、可行,其近远期临床疗效与开腹手术相当。Objective To discuss the surgical feasibility, oncological safety, advantages and disadvantages of laparoscopic radical resection of rectal cancer （RC） by comparing the short- and long-term clinical efficacy between laparoscopic and open surgery. Methods From January 2008 to December 2014, nine hundred and forty-nine RC cases were divided into laparoscopic group （undergoing laparoscopic radical resection） and open group （undergoing open radical resection）. The basic clinical data, surgical parameters, oneological pathology indicators and the postoperation follow-up data were analyzed retrospectively. Results （1） There was no statistical difference on the basic clinical data between the laparoscopic group （394 cases） and the open group （555 cases）. （2） Compared with the open group, the laparoscopic group had less surgical blood loss, preventive colostomy rate, time of fart recovery, defecation recovery and pulling out the abdominal cavity drainage tube, and took shorter time in hospital both of postoperation and the total （P〈0.05）. However, the laparoscopic group took more surgical time and hospitalized costs. Except for the lower incidence of surgical massive bleeding, the laparoscopic group were statistically similar to the incidence of other complications. （3） There was no statistical difference in oncology pathology indicators,tumor recurrence, disease free survival rate and overall survival rate between the two groups. （4） In the subgroup analysis by pTNM stages, the long-term survival between the two groups also had no significant difference. Conclusion The laparoscopic radical resection of rectal cancer is feasible and safe, with similar clinical efficacy as the open surgery.

关 键 词：直肠肿瘤 腹腔镜 剖腹术 治疗结果 

分 类 号：R735.37[医药卫生—肿瘤]