腹腔镜直肠癌根治术的可行性、安全性及肿瘤根治性分析

目的:探讨腹腔镜直肠癌根治术的可行性、安全性及肿瘤根治效果。方法:随机选取2008年2月至2013年2月54例腹腔镜直肠癌根治术患者作为研究对象(腹腔镜组),另选取60例传统开腹直肠癌根治术患者作为对照(开腹组)。对比分析两组患者一般资料、手术时间、手术出血量、术中输血、术后并发症、术后恢复情况,以及手术前后炎性指标、免疫指标、肿瘤标志物变化、手术根治效果。结果:手术均顺利完成,腹腔镜组无一例中转开腹。两组患者一般资料差异无统计学意义(P>0.05);腹腔镜组手术时间长于开腹组,差异有统计学意义(t=5.124,P<0.05),手术出血量腹腔镜组少于开腹组,差异有统计学意义(t=8.108,P=0.000),术中输血两组差异无统计学意义(P>0.05);腹腔镜组术后恢复情况优于开腹组,差异有统计学意义(P<0.05)。术前CRP、CD4+、CD8+、CD4+/CD8+水平两组相比差异无统计学意义(P>0.05);术后第3天、第7天、第10天,腹腔镜组CRP、CD8+均低于开腹组,差异有统计学意义(P<0.05),腹腔镜组CD4+、CD4+/CD8+水平均高于开腹组,差异有统计学意义(P<0.05)。两组患者手术前后血清CA242、CEA、CA724、CA199含量及阳性率差异无统计学意义(P>0.05)。腹腔镜组术后并发症发生率低于开腹组(13%vs.23.3%),但差异无统计学意义(P>0.05)。两组标本长度、淋巴结清扫数量、各站淋巴结转移率、转移度差异无统计学意义(P>0.05)。结论:与开腹手术相比,腹腔镜直肠癌根治术具有安全性高、并发症少、术后住院时间短等优点,手术可行性高、肿瘤根治性彻底,可作为直肠癌根治性治疗的首选方案。

Analysis of the feasibility,safety and effectiveness of radical cure in laparoscopic radical resection of rectal carcinoma

Objective：To evaluate the feasibility,safety and effectiveness of radical cure in laparoscopic radical resection of rectal carcinoma. Methods：Fifty-four cases of laparoscopic radical resection of rectal carcinoma from Feb. 2008 to Feb. 2013 were randomly selected as the laparoscopic group. Sixty cases of traditional open surgery for rectal carcinoma were selected as the open group（control group）. The general information,mean operation time,intraoperative blood loss,intraoperative blood transfusion,postoperative complications,recovery,changes of the preoperative and postoperative levels of inflammatory response,immune function,tumor markers and effectiveness of radical cure between the 2 groups were compared. Results：Laparoscopic surgery and open surgery were both successful in all 114 cases. No patients were converted to laparotomy in the laparoscopic group. No significant difference was found in the general information of patients（P〉0. 05）. The mean operation time in the laparoscopic group was significantly longer than that of the open group（t = 5. 124,P〈0. 05）. The mean intraoperative blood loss in laparoscopic group was less than the open group（t = 8. 108,P = 0. 000）. No significant difference was found in blood transfusion rates of both groups（P〉0. 05）. Postoperative recovery situation in the laparoscopic group was better than the open group（P〈0. 05）. The preoperative levels of CRP,CD4^＋,CD8^＋,CD4^＋/CD8^＋ratio in both groups were not significantly different（ P〉0. 05）. On the 3rd,7th,10 th day after surgery,the postoperative levels of CRP,CD8^＋in the laparoscopic group were lower than the open group（P〈0. 05）;the levels of CD4^＋,CD4^＋/CD8^＋ratio in the laparoscopic group were higher than the open group（P〈0. 05）. The preoperative and postoperative levels and positive rate of CA242,CEA,CA724,CA199 of two groups were not significantly different（P〉0. 05）. The overall complication rate was 13% in the laparoscopic group and23. 3% in the ope