腹腔镜与开腹全直肠系膜切除术治疗低位直肠癌疗效比较

目的比较腹腔镜与开腹全直肠系膜切除术(TME)治疗低位直肠癌的临床疗效。方法 134例低位直肠癌患者分为2组,腹腔镜手术组78例行腹腔镜TME,开腹手术组76例行开腹TME;观察比较2组患者的手术切口长度、手术时间、术中出血量、淋巴结清扫数量、术后胃肠功能恢复时间、术后住院时间、术后并发症、局部复发率、远处转移率及3 a无瘤生存率。结果腹腔镜手术组患者手术时间显著长于开腹手术组(P<0.05),但切口长度、术后胃肠功能恢复时间及术后住院时间均显著短于开腹手术组(P<0.05),术中出血量显著少于开腹手术组(P<0.05);2组患者淋巴结清扫数量、局部复发率和远处转移率比较差异均无统计学意义(P>0.05)。腹腔镜手术组患者3 a无瘤生存率高于开腹手术组(P<0.05)。腹腔镜手术组患者并发症发生率显著低于开腹手术组(P<0.05)。结论腹腔镜TME治疗低位直肠癌具有手术创伤小、术中出血少、术后恢复快、术后并发症少等优点。

Laparoscopic total mesorectal excision and open total mesorectal excision for treating low rectal cancer

Objective To compare the clinical effect of laparoscopic total mesorectal excision(TME)and open TME for low rectal cancers.Methods One hundred and thirty-four patients with low rectal cancers were divided into two groups,seventy-eight patients in laparoscopic operation group were treated with laparoscopic TME,and the seventy-six patients in open operation group were treated with open TME.The length of operative incision,operation time,level of intraoperative bleeding,number of lymph node clearance,postoperative gastrointestinal function recovery time,postoperative hospitalization time,postoperative complications,local recurrence rate,distant metastasis rate and 3-year disease-free survival rate were observed and compared between the two groups.Results The operation time in laparoscopic operation group was significantly longer than that in open operation group(P<0.05),but the length of operative incision,postoperative gastrointestinal function recovery time and postoperative hospitalization time in laparoscopic operation group were significantly shorter than those in open operation group(P<0.05),and the level of intraoperative bleeding in laparoscopic operation group was significantly less than that in open operation group(P<0.05).There was no significant difference in the number of lymph node clearance,local recurrence rate and distant metastasis rate between the two groups(P>0.05).The 3-year disease-free survival rate in laparoscopic operation group was higher than that in open operation group(P<0.05),and the incidence of complications in laparoscopic operation group was significantly lower than that in open operation group(P<0.05).Conclusion Laparoscopic TME for low rectal cancer has the advantages of little surgical trauma,less intraoperative bleeding,rapid postoperative recovery and few postoperative complications.