腹腔镜与开腹全直肠系膜切除术治疗中低位直肠癌的临床对照研究

目的评价腹腔镜全直肠系膜切除术(TME)治疗中低位直肠癌的可行性、安全性、根治性及近期、中期临床疗效。方法回顾性分析我院2005年10月至2008年10月期间行TME的腹腔镜Dixon术式52例和传统开腹Dixon术式46例并无预防性造口的中低位直肠癌患者的临床资料,对2组的手术学指标、术后恢复情况、肿瘤学指标和近期、中期疗效进行比较。结果 2组患者中除腹腔镜组有2例(3.8%)中转开腹外,其余患者手术均获成功,无围手术期死亡患者。腹腔镜组的术中出血量、术后肠道功能恢复时间(排气时间)和切口愈合情况均优于开腹组(P<0.05),而术后吻合口漏和肺部感染情况2组差异无统计学意义(P>0.05)。2组手术切除标本远切缘和环周切缘病理学检查均为阴性;清扫淋巴结数目和肿瘤下缘距远切缘距离比较,2组差异无统计学意义(P>0.05)。2组术后肿瘤相关死亡、局部复发、远处转移和3年生存率差异均无统计学意义(P>0.05)。结论腹腔镜TME安全、可行,具有明显的微创优势,根治效果满意,近期、中期疗效与开腹手术相近。

Laparoscopic Versus Open Total Mesorectal Excision in Treatment of Middle-Low Rectal Cancer:A Clinical Comparative Study

Objective To evaluate the feasibility,safety,radicality,and short-term and mid-term clinical outcomes of laparoscopic total mesorectal excision(TME) in comparison with open procedure for the middle-lower rectal cancer.Methods From October 2005 to October 2008,52 patients with middle-lower rectal cancer received laparoscopic TME(Dixon’operation) without preventive stoma,while 46 patients underwent conventional open TME(Dixon’operation) without preventive stoma.The operative procedures,clinicopathological data,and short-term and mid-term outcomes were collected and compared between the two groups.Results The other patients were successful in both groups in addition to 2(3.8%) patients were converted to open procedure in laparoscopic TME group.There was no perioperative death in both groups.The intraoperative blood loss,the time for bowel movement retrieval(first flatus),and the incision healing in laparoscopic TME group were better than that in open TME group(P<0.05).No significant differences were observed between two groups in anastomotic leakage and pulmonary infection(P>0.05).Comparison of specimen,no significant differences were observed between two groups in negative distal margin and circumferential resection margin,number of lymph nodes resected,distance of distal resection margin to the tumor(P>0.05).No significant differences were observed between two groups in cancer-related death,local recurrence,distant metastasis,and 3-year survival rate(P>0.05).Conclusions Laparoscopic TME for middle-low rectal cancer is a safe,feasible,and minimally invasive technique,and can achieve satisfactory oncological outcome,which provides similar short-term and mid-term outcome compared with the traditional open procedure.