腹腔镜与开腹经腹会阴直肠切除术治疗低位直肠癌的疗效对比:基于倾向性匹配分析  

Laparoscopic versus open abdominoperineal rectal resection for the treatment of low rectal cancer: based on propensity matching analysis

作　　者：徐逸昕[1] 奚诚 叶年源[1] 王一波[1] XU Yi-xin;XI Cheng;YE Nian-yuan;WANG Yi-bo(Department of General Surgery,Wujin Hospital Affiliated to Jiangsu University,Changzhou Jiangsu 213002,China)

机构地区：[1]江苏大学附属武进医院普外科

出　　处：《江苏大学学报（医学版）》2019年第4期351-355,共5页Journal of Jiangsu University：Medicine Edition

摘　　要：目的:通过对比腹腔镜与开腹经腹会阴直肠切除术(abdominoperineal resection,APR)治疗低位直肠癌的各项临床病理结果来分析两种术式的优劣。方法:收集2012年1月至2016年1月于江苏大学附属武进医院普外科行APR的直肠癌患者临床资料。用倾向性匹配分析方法来消除接受腹腔镜手术以及开腹手术治疗患者的一般情况差异。对比分析腹腔镜组与开腹组术后血液、病理检查结果与生存情况。结果:共有158例患者入组(腹腔镜组84例,开腹组74例)。经过排除标准筛选后剩余139例。倾向性匹配分析(1∶1)后每组各有49例,并且两组之间术前临床病理特征无明显差异。相比开腹组,腹腔镜组术中出血量更少,手术后血红蛋白、白蛋白含量较高,术后腹腔感染、切口感染比例更低,术后并发症严重程度更轻,恢复经口进食时间、术后住院时间更短,但住院费用较高(P均<0. 05)。两组患者总生存期差异无统计学意义(P=0. 754,95%CI:0. 467~2. 864)。结论:在治疗低位直肠癌患者时,两种手术方式的远期疗效相近,但腹腔镜手术的近期疗效更好。Objective: To evaluate the advantages of laparoscopic and open abdominoperineal resection( APR) by comparing clinicopathological results of the two methods. Methods: We collected clinical data from consecutive patients who underwent APR for rectal cancer from January in 2012 to January in2016,compared the surgical outcomes and long-time survival of a laparoscopic surgery group( LG) with those of an open surgery group( OG). Results: A total of 158 patients were analyzed,with 84 in LG and74 in OG. A total of 139 patients were kept. Then each group had 49 cases by using propensity matching analysis( 1 ∶ 1). The perioperative clinical and pathological factors between two groups had no significant difference. Compared with OG,LG had less intraoperative bleeding and decline of hemoglobin,albumin and globin affected by surgery,lower rate of postoperative infection of abdominal and surgical site,lighter severity degree of postoperative complications,shorter resumed oral intake time and postoperative hospitalization lengths and higher hospital charges( all P < 0. 05). However,there was no significant difference in prognosis between two groups( P = 0. 754,95% CI: 0. 467-2. 864). Conclusion: The laparoscopic surgery has better short-term and similar long-term outcomes in treating patients with rectal cancer.

关 键 词：腹腔镜 开腹 经腹会阴直肠切除术 疗效 倾向性匹配分析 

分 类 号：R735.3[医药卫生—肿瘤]