两种腹腔镜直肠癌根治术和传统开腹手术的对比研究

目的探讨两种腹腔镜直肠癌根治术和传统开腹手术的临床疗效。 方法回顾性分2012年3月至2014年12月行直肠癌根治术的患者184例，其中开腹组58例，2D腹腔镜组65例，3D腹腔镜组61例；比较3组患者术中情况、术后情况以及手术并发症等情况。应用Stata13.0统计软件包进行分析。年龄、BMI指数、术中及术后等计量资料( ±s)表示，比较采用方差分析；计数资料比较采用卡方检验。本研究以P<0.05为差异有统计学意义，术后生存资料分析采用Kaplan－Meier法。 结果2D腹腔镜组和3D腹腔镜组出血量、愈合时间、排气时间和住院时间均较开腹组显著降低(P<0.05)；3D腹腔镜组患者手术时间较2D腹腔镜组显著降低(P<0.05)，但与开腹组间比较无显著差异(P>0.05)；3D腹腔镜组伤口感染率和术后尿潴留发生率明显低于开腹组(P<0.05)；三组之间术后肺感染、肠梗阻和吻合口漏的发生率比较，差异无统计学意义(P>0.05)。三组之间3年生存率与无瘤生存时间差异无统计学意义(P>0.05)。 结论3D腹腔镜直肠癌根治术手术时间短，术后并发症少，术后无瘤生存时间与生存率均较高，值得临床推广。

Comparative investigation of 2D and 3D laparoscopic radical resection and laparotomy in treating rectal cancer

ObjectiveTo explore the clinical effect of 2D and 3D laparoscopic radical resection and laparotomy in treating rectal cancer. MethodsFrom March 2012 to December 2014, 184 patients with rectal cancer were enrolled in this study, including 58 cases in open group, 65 cases in 2D laparoscopy group and 61 cases in in 3D laparoscopy group. Clinical data were analyzed by using statistical software SPSS 13.0. Measurement data such as age, BMI, intraoperative and postoperative indicators were expressed as mean±standard deviation, and were examined by using analysis of variance. Count data were examined by using χ² test. Kaplan-meier method was used to analyze the postoperative survival. A P value <0.05 was considered as statistically significant difference. ResultsThe blood loss, healing time, exhaust time and hospital stay of 2D laparoscopic group and 3D laparoscopic group were significantly lower than those in the open group (P<0.05). The operation time of 3D laparoscopic group was significantly less than that of 2D laparoscopic group (P<0.05), however there was no significant difference of the operation time between 3D laparoscopic group and open group (P>0.05). The incidence of wound infection and postoperative urinary retention in 3D laparoscopic group was significantly lower than those in open group (P<0.05). There was no significant difference in terms of incidence of pulmonary infection, intestinal obstruction and anastomotic leakage among 3 groups (P>0.05). There was no significant difference of 3-year survival rate and DFS among 3 groups (P>0.05). Conclusion3D laparoscopic radical resection of rectal cancer has shorter operation time, less postoperative complications, higher postoperative survival time and higher survival rate, which is worthy of clinical promotion.