腹腔镜全直肠系膜切除术治疗低位直肠癌的疗效观察

目的探讨腹腔镜全直肠系膜切除术(TME)治疗低位、超低位直肠癌的临床疗效。方法将86例低位直肠癌患者随机分为观察组和对照组,每组各43例,观察组患者行腹腔镜TME,对照组患者行开腹TME,术后观察两组患者的手术相关指标、肿瘤根治性指标、术后恢复指标、费用、术后并发症。结果观察组术中出血量少于对照组(P0.05);观察组的手术时间、术后肛门排气时间、留置导尿时间、术后住院时间均短于对照组(P0.05);观察组术后的切口感染、肠粘连、尿潴留明显少于对照组(P0.05);观察组的肿瘤大小、切除标本长度、吻合口瘘发生率、清扫淋巴结数目、肿瘤远端切缘长度及肿瘤分期等方面与对照组比较差异无显著统计学意义(P0.05);但观察组的手术费用、住院总费用高于对照组(P0.05)。结论腹腔镜TME治疗低位、超低位直肠癌疗效确切,具有创伤小、疼痛轻、出血量少、肛门恢复排气时间快、术后并发症发生率低、疗程短及预后好等优点,整体上较为安全可靠,值得临床广泛应用。

Effect of Laparoscopic Total Mesorectai Excision for Low and Ultro-Low Rectal Carcinoma

Objective To discuss the clinical efficacy of laparoscopic total mesorectal excision （TME） in treatment for low and ultra-low rectal cancer. Methods Eighty-six patients with rectal cancer were randomly divided into observation group and control group,with 43 cases in each group. The observation group was treated by the laparoscopic TME, and the control group was treated by the open TME. The surgical related indicators, indicators of radical tumor, postoperative recovery targets, costs, postoperative complications in the two group were observed. Results The bleeding volume of the observation group was less than the control group （P 〈0.05）. In the observation group, the operative time, postoperative anal exhaust time, catheterization time, postoperative hospital stay were all shorter than the control group （ P〈0.05）. The rates of wound infection, intestinal adhesion, urinary retention of the observation group were significantly less than the control group （ P〈0.05 ）. The tumor size, length of resected specimen, the incidence of anastigmatic leakage, the number of lymph nodes, tumor length and the distal edge of the tumor stage were considerable between the two groups （ P 〉0. 05）. On the other hand, the surgery costs, total cost of hospitalization of the pobservation grou were higher in the obeservation group （P 〈0. 05）. Conclusion Laparoscopic TME treatment of low and ultra-low rectal cancer, with less trauma, less pain, less bleeding, fast anal exhaust time, low incidence of postoperative complications, short course and prognosis, are on the whole more safe and reliable, and it＇s worthy of wider application.