腹腔镜结直肠癌根治术与同期开腹手术的回顾性研究

目的回顾性分析比较腹腔镜结直肠癌根治术与同期开腹手术患者的临床资料,探讨应用腹腔镜技术行结直肠癌根治术的可行性。方法 2004年8月至2009年4月腹腔镜辅助下结直肠手术184例,右半结肠癌根治术37例,横结肠癌根治术11例,左半结肠癌根治术31例,直肠癌Dixon手术53例、Miles手术49例、Hartmann手术3例;开腹结直肠癌根治术患者718例（开腹组）,其中右半结肠癌根治术107例,横结肠癌根治术54例,左半结肠癌根治术131例,直肠癌Dixon手术288例、Miles手术117例、Hartmann手术21例,对照比较两组患者的手术及术后情况。结果两组均无术中、术后严重并发症和手术死亡病例,腹腔镜组有4例中转开腹手术。腹腔镜组与开腹组的平均手术时间分别为（210.5±26.5）min和（95.5±12.5）min,差异有显著性（P〈0.05）。腹腔镜组术中失血量明显少于开腹组〔（85.5±12.5）ml比（200.5±22.5）ml,P〈0.05〕。清除的淋巴结数量,直肠前切除肿瘤远端切缘长度两组间差异无显著性。腹腔镜组术后胃肠功能恢复时间明显早于开腹组〔进食时间：（4.5±0.5）d比（5.5±0.5）d,P〈0.05）。腹腔镜组住院时间明显短于开腹组〔（9.5±0.5）d比（12.5±0.5）d,P〈0.05〕。两组的3,5年生存率比较差异无显著性（89.8%比89.7%,P〉0.05;75.5%比74.5%,P〉0.05）。结论腹腔镜结直肠癌切除术安全、有效,具有可行性。

Retrospective study on laparoscopic versus open radical rection of colorectal cancer

Objective To compare the clinical data of laparoscopic vs. open radical rectection of colorectal cancer and to study the feasibility and curative effect of laparoscopic radical resection of colorectal cancer. Methods 184 cases who underwent laparoscopic operation（ 37,11,31,53,49 and 3 cases underwent radical right colectomy,radical transverse colectomy,radical left colectomy,Dixon,Miles and Hartmann operations respectively） and 718 cases who underwent open operation（ 107,54,131,288,117 and 21 cases underwent radical right colectomy,radical transverse colectomy,radical left colectomy,Dixon,Miles and Hartmann operations respectively） in our department from Aug. 2004 to Apr 2009 were included. The clinical data of patients in two groups were compared. Results No severe complication and death occurred in both groups and 4 cases in laparoscopic group were changed to open operation during the procedure. The mean operation time of laparoscopic group and open group was（ 210. 5 ± 26. 5） min and（ 95. 5 ± 12. 5） min respectively,with statistical difference between them（ P 0. 05） . The intraoperative blood loss in laparo-scopic group was obviously less than that in open group（ 85. 5 ± 12. 5） ml vs（ 200. 5 ± 22. 5） ml,P 0. 05. There was no statistical difference of the number of cleared lymph nodes and the length of distal incision margin of tumor anterior to rectum between two groups（ 2. 1 ± 0. 3） cm vs. （ 2. 2 ± 0. 4） cm,P 0. 05. The gastrointestinal function recovered more quickly in laparoscopic group than in open group（ 4. 5 ± 0. 5） d vs. （ 5. 5 ± 0. 5） d for intake of diet,P 0. 05. The length of hospital stay was shorter in laparo-scopic group than in open group（ 9. 5 ± 0. 5） d vs. （ 12. 5 ± 0. 5） d,P 0. 05. There was no statistical difference in 3-year survival rate or 5-year survival rate between the two groups. Conclusion Laparoscopic radical rectectomy and colectomy for colorectal cancer is feasible and safe with minimal invasiveness.