腹腔镜超低位直肠癌经腹会阴联合切除会阴人工肛门重建术的疗效观察

目的探讨腹腔镜超低位直肠癌经腹会阴联合切除会阴人工肛门重建术的安全性和临床疗效。方法回顾性分析2006年4月至2010年2月期间解放军第150中心医院全军肛肠外科研究所收治的102例超低位直肠癌行经腹会阴联合切除会阴人工肛门重建术的患者,其中腹腔镜手术58例（腹腔镜组）,开腹手术44例（开腹组）。观察指标包括手术时间、术中失血量、检出淋巴结数目、术后恢复流质饮食时间、术后首次肛门排气时间、术后住院时间、术后并发症等;采用Kaplan-Meier法计算生存率并经log-rank检验,计量资料采用t检验,计数资料采用χ2检验。结果腹腔镜组和开腹组的一般临床病理资料比较差异均无统计学意义（P〉0.05）。2组均顺利完成手术,无与手术相关的死亡病例。腹腔镜组的手术时间略长于开腹组,但差异无统计学意义（P〉0.05）;腹腔镜组的术中失血量明显少于开腹组,差异有统计学意义（P〈0.05）;腹腔镜组的术后首次肛门排气时间、术后恢复流质饮食时间及术后住院时间均明显短于开腹组,差异均有统计学意义（P〈0.05）;腹腔镜组检出淋巴结枚数明显多于开腹组,差异有统计学意义（P〈0.05）。2组并发症发生率比较,差异无统计学意义（P〉0.05）。2组患者的生存曲线比较,差异无统计学意义（P=0.897）。结论腹腔镜超低位直肠癌经腹会阴联合切除会阴人工肛门重建手术与开腹直肠癌手术能达到同样的疗效,且其创伤小、术后恢复快、安全可行。

Clinical Effect of Laparoscopic Miles and Perineal Anal Reconstruction Operation for Patients with Low Rectal Cancer

Objective To evaluate the safety and clinical effect of laparoscopic Miles and perineal anal recon- struction operation for patients with low rectal cancer. Methods One hundred and two patients underwent Mile＇s and perineal anal reconstruction operation for rectal cancer in this hospital from April 2006 to February 2010 were analyzed retrospectively, in which 58 patients underwent laparoscopic surgery （laparoscope group） and 44 patients underwent open surgery （laparotomy group）. All these data such as the survival time, operative time, intraoperative blood loss, harvested lymph nodes, the first anal exhaust time and liquid diet recovery time after operation, postoperative hospitalization, and postoperative complications were collected and compared between the laparoscope group and laparotomy group. Results The demography and clinicopathologic characteristics were similar between these two groups （P〉0. 05）. The operation was successfully performed in all the patients. There was no death associated with the operation. Compared with the laparotomy group, the intraoperative blood loss was less G~〈0. 05）, the first anal exhaust time and liquid diet recovery time after operation, postoperative hospitalization were shorter （P 〈 0. 05）, the harvested lymph node was more （P 〈 0. 05） in the laparoscope group. There were no significant differences in the operative time, postoperative complications, and the survival curves between the two groups （P〉 0. 05）. Conclusions The clinical effects of laparoscopic and open Miles and perineal anal reconstruction operation are similar for patients with low rectal cancer. But laparoscopic operation is a safe, feasible choice with quicker recover after the operation.