腹腔镜直肠癌根治术与开腹直肠癌根治术的临床对照研究  

Comparison of the clinical efficacy of laparoscopic and open radical resection of rectal cancer

作　　者：徐传奇 史友权[1,3] 吕剑[2] 蒋学通 王森[4] 汤东[1] 王伟[1] 崇杨[1] 徐明皓[1,3] 张琪[1,5] 王道荣 

机构地区：[1]江苏省苏北人民医院胃肠中心,扬州225001 [2]江苏省靖江市人民医院普外科,靖江214500 [3]大连医科大学,116044 [4]南京医科大学附属第一临床医学院,210000 [5]扬州大学医学院,225001

出　　处：《中华结直肠疾病电子杂志》2017年第5期397-401,共5页Chinese Journal of Colorectal Diseases(Electronic Edition)

基　　金：重点病种规范化诊疗项目(No.BE2015664)

摘　　要：目的分析比较腹腔镜与开腹直肠癌根治术的临床疗效。方法选取江苏省苏北人民医院胃肠外科自2009年9月至2015年1月期间手术的380例直肠癌患者的临床数据,其中腹腔镜下直肠癌根治术(腔镜组)190例,开腹直肠癌根治术(开腹组)190例,回顾性分析两组患者的临床资料,对比分析两组样本的术中出血量、手术时间、淋巴结清扫数、术后引流量,术后并发症、术后住院时间、术后随访等数据。结果两组患者在术中出血量(t=-9.06,P<0.001)、术中淋巴结清扫数(t=2.07,P=0.039)、术后住院时间(t=2.87,P=0.004)、手术时间(t=5.43,P<0.001)、切口感染(Χ~2=4.49,P=0.03)、性功能障碍(Χ~2=4.43,P=0.04)、肠梗阻(Χ~2=4.49,P=0.03)等方面差异具有统计学意义,两组在术后3天引流量(t=1.024,P=0.306)、转移淋巴结数(t=0.70,P=0.484)和术后生存率(Χ~2=0.74,P=0.39)方面差异无统计学意义。结论腹腔镜与开腹直肠癌根治术都是安全可行的无瘤手术方式,两种方式各有优劣,目前仍缺乏相关的前瞻性临床随机对照试验。Objective To compare the curative effect of laparoscopic and open radical resection of rectal cancer. Methods The clinical data of 380 patients with rectal cancer that had received operation from September 2009 to January 2015 in Gastrointestinal Surgery Department of Subei People Hospital were selected, and there were 190 cases of laparoscopic assisted rectal cancer radical resection（laparoscopic group）, and 190 cases of open rectal cancer radical resection（open group）.A retrospective analysis was conducted on the clinical data of two groups and the intraoperative blood loss, operative length, lymph node dissection number, postoperative drainage volume, postoperative complications, postoperative discharge time, postoperative follow-up data of two groups were compared and analyzed. Results Patients from two groups had significant difference in intraoperative blood loss（t=9.06, P 0.0001）, lymph node dissection number（Χ~2=2.07, P=0.039）, postoperative hospital stay（Χ~2=2.87, P=0.004）, operative length（t=5.43, P 0.001）, infection of incision（Χ~2=4.49, P=0.03）, Sexual dysfunction（Χ~2=4.43, P=0.04） and intestinal obstruction（Χ~2=4.49, P=0.03）. The laparoscopic assisted rectal cancer radical resection had less intraoperative blood loss, more intraoperative lymph node dissection number, shorter postoperative hospital stay, less infection of incision, less Intestinal obstruction and less Sexual dysfunction etc., while the open group had shorter operation length. They had no statistical significance in post-operative drainage volume within three days（t=1.024, P=0.306）, the number of lymph node metastasis（Χ~2=0.70, P=0.484）, and survival rate after operation（Χ~2=0.74, P=0.39）. Conclusion Laparoscopic and open radical resection of rectal cancer are safe and feasible surgical approach, both ways have their own advantages and disadvantages, is still lack of related prospective clinical randomized controlled trials.

关 键 词：直肠肿瘤 腹腔镜 开腹手术 疗效 并发症 

分 类 号：R735.37[医药卫生—肿瘤]