腹腔镜腹会阴联合切除术治疗低位直肠癌疗效评价

目的前瞻性评估腹腔镜直肠癌腹会阴联合切除术的临床优劣性。方法将2003年7月至2006年4月收治的低位直肠癌患者随机分为两组，37例行腹腔镜腹会阴联合切除术（腹腔镜组），另37例常规开腹行腹会阴联合切除术（开腹组）；比较两组的手术时间、清除淋巴结数目和腹部出血量、术后排气时间、起床活动时间、住院时间、并发症发生率和复发转移率及卫生经济学情况。结果腹腔镜全组患者均顺利完成手术，无中转开腹者；手术时间两组比较差异无统计学意义（P〉0．05），但前10例手术时间比开腹组长（P〈0．01）；腹部出血量少于开腹组（P〈0．01）．但前10例较开腹组多（P〈0．01）；术后肛门排气时间两组差异无统计学意义（P〉0．05）；起床活动时间腹腔镜组早于开腹组（P〈0．01）；住院时间长短两组无差异，但腹腔镜会阴闭合较开腹组早：腹腔镜组腹部创口相关并发症明显少于开腹组（P〈O．05）；两组的清除淋巴结枚数、局部复发及远处早期复发率差异无统计学意义（P〉0．05）；手术费用腹腔镜组明显高于开腹组，但医疗总费用两组差异无统计学意义（P〉0．05）。结论腹腔镜直肠癌腹会阴联合切除术不仅创口小、术中出血少、与腹部创口相关并发症少、术后恢复快，且其手术时间、医疗总费用和肿瘤根治性与开腹手术无差异。

Laparoscopic abdominoperineal resection for low rectal cancer

Objective To assess the advantage and disadvantage of laparoscopic abdomino-perineal resection and open abdominoperineal resection for low rectal cancer. Methods Patients with low rectal cancer,collected from July 2003 to April 2006,were randomly divided into laparoscopic abdominoperineal resection group(37 cases) and open abdominoperineal resection group(37 cases). Operation time,number of lymph node removed,intra-operative blood loss,time to pass flatus,time to ambulate,time to discharge,complications,early recurrence,and economical cost were compared between the 2 groups. Results All patients were performed successfully.For the first 10 patients,operation time of laparoscopic group was significantly longer than that of open group,but there was no significant difference between the 2 groups. Intra-operative blood loss of laparoscopic group was significantly less than that of open group,but it was reverse for the first 10 patients. There was no significant difference in time to pass flatus between the 2 groups. Time to ambulate in laparoscopic group was significantly earlier than that in open group. There was no significant difference in time to discharge between the 2 groups,but it was earlier for perineum closure in laparoscopic group. Relative complications of laparoscopic group,including pulmonary infection,abdominal wound infection or split,were significantly less than those of open group. There was no significant difference in number of lymph nodes removed,early recurrence between the 2 groups. Operation cost of laparoscopic group was significantly higher than that of open group,but there was no significant difference. Conclusion Advantages of laparoscopic abdominoperineal resection were characterized for not only minimal invasion and good cosmetic outcome but also less blood loss,complications,and earlier postoperative recovery. The operation time,total costs and oncological clearance of laparoscopic abdominoperineal resection patients were comparable with those of open procedure patients.