非气腹完全腹腔镜与气腹腹腔镜辅助直肠癌全直肠系膜切除术的对比研究

目的：探讨非气腹完全腹腔镜直肠癌全直肠系膜切除术（ total mesorectal excision， TME）的临床价值。方法回顾比较我院2006年6月～2013年9月年龄＞66岁，因直肠癌接受非气腹完全腹腔镜直肠癌TME（n＝35）和气腹腹腔镜辅助直肠癌TME（ n＝33）的临床资料，比较2组手术时间、术中出血量、术后住院时间、术后并发症、清扫淋巴结数目、术后48 h引流量、肛门排气时间、进流质饮食时间、远切缘距病灶边缘距离。结果非气腹完全腹腔镜组手术时间（195．2±28．4） min，明显短于气腹腹腔镜辅助组（215．9±37．4）min（t＝2．559，P＝0．013）；术中出血量（125．3±39．8）ml，与气腹腹腔镜辅助组（130．1±45．0）ml无统计学差异（t＝-0．467，P＝0．642）；清扫淋巴结（11±4）枚，与气腹腹腔镜辅助组（12±5）枚无显著性差异（t＝-0．913，P＝0．364）；肛门排气时间（2．2±0．3）d，明显短于气腹腹腔镜辅助组（3．8±0．5）d（t＝-16．108，P＝0．000）；术后住院时间（5．2±1．3）d，明显短于气腹腹腔镜辅助组（8．1±2．2）d（t＝6．663，P＝0．000）；进流质饮食时间（3．2±0．7）d，明显短于气腹腹腔镜辅助组（4．6±0．4）d（t＝-10．044，P＝0．000）；远切缘距病灶边缘距离（4．2±0．7）cm，明显长于气腹腹腔镜辅助组（3．3±0．5）cm（t＝6．068，P＝0．000）；手术耗材费用（4920．10±665．6）元，明显少于气腹腹腔镜辅助组（7460．8±124．2）元（t＝-21．568，P＝0．000）。非气腹完全腹腔镜组无辅助切口，气腹腹腔镜辅助组术后切口并发症发生率36．4％（12／33），2组切口并发症有统计学差异（Fisher’s检验，P＝0．000）。结论非气腹完全腹腔镜直肠癌TME避免气腹对人体血流动力学的影响，无腹部辅助切口，更加美观，术后肠道恢复快，住院时间短，可达到腹腔镜辅?

Comparative Study of Gasless Laparoscopic versus Laparoscopic-assisted Total Mesorectal Excision

Objective To evaluate the clinical value of gasless laparoscopic total mesorectal excision （TME）. Methods Clinical data of patients （older than 66 years old） with rectal cancer in our hospital from June 2006 to June 2013, treated either by gasless laparoscopic TME （ n =35 ） or laparoscopic-assisted TME （ n =33 ） , were reviewed retrospectively.The operation time, intraoperative blood loss, postoperative hospital stay, postoperative complications, number of lymph node removed, drainage volume 48 hours after surgery, time to flatus, time to liquid diet, distance from distal cutting edge to lesion, and operative expenditure were compared between the two groups. Results The operation time was significantly shorter in the gasless group [（195.2 ±28.4） min] than that in the laparoscopic-assisted group [（215.9 ±37.4） min,t=2.559,P=0.013].There were no significant differences in blood loss [（125.3 ±39.8） ml vs.（130.1 ±45.0） ml, t=-0.467, P=0.642] and number of lymph nodes [（11 ±4） vs. （12 ±5）, t=-0.913, P=0.364] between the gasless group and the laparoscopic-assisted group.The time to flatus was significantly shorter in the gasless group [（2.2 ±0.3） d] than that in the laparoscopic-assisted group [（3.8 ±0.5） d, t=-16.108, P=0.000].The length of postoperative hospital stay was significantly shorter in the gasless group [（5.2 ±1.3） d] than that in the laparoscopic-assisted group [（8.1 ±2.2） d, t=6.663, P=0.000].The time to liquid diet was significantly shorter in the gasless group [（3.2 ±0.7） d] than that in the laparoscopic-assisted group [（4.6 ±0.4） d, t=-10.044, P=0.000].The distance from distal cutting edge to the lesion was significantly longer in the gasless group [（4.2 ±0.7） cm] than that in the laparoscopic-assisted group [（3.3 ±0.5） cm, t=6.068, P=0.000].The operation expenditure was significantly less in the gasless group [（4920.10 ± 665.6） yuan] than that in the laparoscopic-assisted group [（7460.8 ±124.2） yuan, t=-21.