腹腔镜直肠癌根治术44例体会

目的:探讨腹腔镜直肠癌根治术的可行性和手术方法。方法:回顾分析2008年9月至2011年5月94例直肠癌患者的临床资料,分别行腹腔镜直肠癌根治术和传统开腹直肠癌根治术,比较手术时间、出血量、并发症、清扫淋巴结数、术后排气时间、住院时间等。结果:腹腔镜组与传统开腹组患者手术时间分别为(2.5±0.3)h及(2.1±0.4)h(P>0.05);出血量分别为(120±8)ml及(220±10)ml(P<0.05);并发症分别为13%及20%(P<0.05);清扫淋巴结数分别为(16±2)枚及(17±3)枚(P>0.05);术后排气时间分别为(52.5±6.5)h及(81.2±9.0)h(P<0.05);住院时间分别为(8.3±1.6)d及(11.2±2.7)d(P<0.05)。结论:腹腔镜直肠癌根治术创伤小,术后恢复快,根治效果同开腹手术,术中Trocar位置的选择、Toldt间隙及骶前间隙的辨别、对肿瘤的包裹隔离,是进一步完善手术的必要步骤。

Analysis of laparoscopic radical resection in 44 cases with rectal cancer

Objective:To explore the feasibility of laparoscopic radical resection for rectal carcinoma and its operative technique.Methods:Retrospective analysis on the data of 94 patients with rectal cancer treated by laparoscopic radical resection or open radical resection from September 2008 to May 2011 was performed.The data was including the operative time,blood loss,operative complication rate,clearance of lymph nodes condition,recovery time of intestinal function and hospital stay.Results: The operative time of laparoscopic and open radical resection on rectal cancer were 2.5±0.3h,2.1±0.4h,respectively.The blood loss of laparoscopic operation was 120±8ml,compared with 220±10ml(P<0.05)on open operation.The operative complication rate was 13% in laparoscopic operation,lower than open operation.The number of cleared lymph nodes was 16±2 and 17±3(P>0.05)in two groups.The average recovery time of intestinal function was(52.5±6.5)h and(81.2±9.0)h.The hospital stay was 8.3±1.6d and 11.2±2.7d(P<0.05).Conclusion: Laparoscopic radical resection is superior to open surgery with less surgical trauma and rapid recovery.The trocar position during the operation,the identification of toldt space and presacral space,and the isolation of tumor are necessary to improve the surgical technique.