腹腔镜下全直肠系膜切除术治疗直肠癌的近期疗效分析

目的 对比分析腹腔镜(LS)和开腹(OS)直肠癌根治术后直肠癌患者的近期疗效.方法 选择2005年12月至2007年1月接受腹腔镜和开腹直肠癌根治术的患者(共221例)的病例资料,回顾性对比分析两组患者的手术时间、手术失血量、清扫淋巴结数目、切缘病理学检查、并发症发生率、恢复饮食时间、住院时间等的差别.结果 腹腔镜组的手术时间明显长于开腹组,差异有统计学意义(LS:175min,OS:146min,P<0.05),在清除淋巴结数目(LS:17个,OS:16个,P>0.05)、切缘阳性率(LS:1.4%,OS:2.7%,P>0.05)方面两者差异无统计学意义,但在手术失血量(LS:175mL,OS:146mL,P<0.05)和术后并发症(LS:17.8%,OS:22.6%,P<0.05)方面,腹腔镜组明显低于开腹组;腹腔镜组的恢复饮食时间、住院天数较开腹组明显缩短.结论 腹腔镜直肠癌根治术在减少手术失血量、缩短住院天数、减少术后并发症等方面较开腹组有着明显的优势,近期疗效与开腹组比较差异无统计学意义,其远期疗效有待进一步随访研究.

An analysis of short-term outcomes of radical operation for rectal cancer by laparoscopic and open surgery

Objective To compare the short-term outcomes of radical operation for rectal cancer by laparoscopic and open surgery.Methods Radical operations by laparoscopic and open surgery were performed in 221 patients from December 2005 to January 2007.The data about the patients' demongraphics,operative details,postoperative outcome,oncological result and disease status were collected prospectively.Comparison of the outcome between laparoscopic and open resection was performed.Results The operating time was longer in the laparoscopic group(175min vs 146 min,P<0.05),but the blood loss and postoperative complications were less(175mL vs 225mL,and 17.8% vs 22.6%,P<0.05).The patients with laparoscopic resection had an earlier return of bowel function as well as a shorter median hospital stay(9.2d vs 16.5d,P<0.05).There was no difference in the number of harvested lymph node(17 vs 16)and positive circumferential margin(1.4% vs 2.7%)between the two groups.Conclusion The radical operation for rectal cancer by laparoscopic technique is quite safe,the short-term outcomes of laparoscopic rectomy were comparable or superior to that of open surgery.