腹腔镜与开腹直肠癌TME保肛术后肛门功能对比研究

目的探讨腹腔镜和开腹直肠癌根治术对肛门功能的影响。方法选择2009年6月至2010年1月间行全直肠系膜切除术（TME）的47例直肠癌患者作为研究对象。根据手术方式，将患者分为腹腔镜组和传统开腹组，其中腹腔镜组26例，传统开腹组21例。对两组患者术后的临床资料进行前瞻性分析，比较两组患者术后肛门功能的差异。结果两组患者在年龄、性别、肿瘤分期和肿瘤病理分型等方面差异无统计学意义。与开腹手术相比，腹腔镜组术中出血量较少、术后排气时间较早、术后住院时间较短，但手术时间腹腔镜组略长于开腹组。术后3个月、6个月、12个月腹腔镜组和开腹组肛门功能的优良率分别是80．8％和76．2％、84．6％和90．5％、100％和95．2％，两组相比差异无统计学意义。术后3个月、6个月、12个月两组患者肛门测压结果相比也基本相似，差异无统计学意义。结论腹腔镜TME术后肛门功能障碍的发生率与开腹手术相比差异无统计学意义，但具有明显的微创优势。

Clinical comparison of anal function following laparoscopic or open TME for patients with rectal cancer

Objective To compare the results of anal function following laparoscopic or open TME for patients with rectal cancer. Methods Forty-seven patients undergoing TME with laparoscopy or laparotomy during the period of June 2008 to January 2010 were included. Among the patients,26 received laparoscopic operation （ laparoscopic group ） and the other 21 received traditional open operation （ open group ） according to their wills. The clinical data of the patients were prospectively analyzed and the anal function were compared between the two groups. Results There were no significant differences in age, sex,tumor stage and histologic types between the two groups. The intraoperative blood loss of laparoseopie group was obviously less than that in open group （ 65 ± 15.7 vs 298 ± 37.4 ml , P 〈 0.05 ）. The time of passage of gas by anus and hospital stay in laparoscopic group were significantly shorter than those in open group （ 2.3 ± 2.1 vs 3.9 ± 2.7 d , 9.7 ± 2.9 vs 13.4 ± 4.6 d ,respectively, P 〈 0.05 ）. However,the operating time for laparoscopic operation is longer （ 207 ± 29.7 vs 161 ± 23.2 rain , P 〈 0.05 ）. The excellent rates of postoperative anal function in the two groups were 80.8 % vs 76.2 % at 3th month, 84.6 % vs 90.5 % at 6th month and 100 % vs 95.2 % at 12th month. There were no significant difference in excellent rates of anal function between two groups. Nor was there a significant difference in anorecta] manometry results in laparoscopic group compared with open group. Conclusions Laparoscopic TME can achieve the same anal function as traditional open operation. And laparoscopic operation can also offer patients significant minimally invasive advantages.