腹腔镜和开腹结直肠癌根治术的远期疗效研究

目的 探讨腹腔镜和开腹结直肠癌根治术在远期疗效方面的差异。方法将1996年1月至2000年9月问215例需行结直肠癌根治术的患者根据本人意愿非随机地分为开腹组和腹腔镜组，对比两组患者术后的5年生存率、局部复发率和远处转移及远期并发症。结果开腹组128例，腹腔镜手术组87例；两组在年龄、性别、肿瘤分期方面差异均无统计学意义（P〉0．05）。5年累计生存率开腹组70％，腹腔镜组78％，两组比较差异无统计学意义（P〉0．05）。开腹组局部复发33例，远处转移34例，切口种植2例，切口疝4例，粘连性肠梗阻30例；腹腔镜组局部复发20例，远处转移22例，切口种植1例，切口疝2例，粘连性肠梗阻11例。两组局部复发率、远处转移率、切口种植率和切口疝发生率比较差异均无统计学意义（P值分别为0．641、0．505、1．00和1．00）；但腹腔镜组术后粘连性肠梗阻发生率较开腹组少（P〈0．05）。结论腹腔镜结直肠癌根治术远期疗效与开腹手术相似，但术后远期并发症少，值得推广。

Comparative study on long- term results of laparoscopic and open radical resection for colorectal carcinoma

OBJECTIVE: To compare the long-term results of laparoscopic and open radical resection for colorectal carcinoma. METHODS: Two hundred and fifteen patients with colorectal cancer from January 1996 to September 2000 were non-randomly divided into laparoscopic and open operation groups. Local recurrence, distant metastasis, 5-year survival rate and long-term postoperative complications were compared between the two groups. RESULTS: Eighty-seven cases received laparoscopic resection and 128 cases received open operation. There were no statistical differences in age, sex and tumor stage between the two groups (P > 0.05). The 5-year-survival rate was 70% in open operation group, and 78% in laparoscopic group (P > 0.05). There were no significant differences in the incidences of local recurrence, distant metastasis, incision seeding, and incision hernia between the two groups (P > 0.05). The complication rate of postoperative adhesive intestinal obstruction was significantly lower in laparoscopic group than that in open operation group (P< 0.05). CONCLUSIONS: Long-term results of laparoscopic resection are similar to those of open resection for colorectal carcinoma, but laparoscopic surgery has less long-term complications.