腹腔镜在直肠癌根治术中的应用

目的:探讨腹腔镜手术治疗直肠癌的微创优势,提高直肠癌的疗效并减少并发症的发生。方法:回顾分析2002年5月至2007年10月山东大学齐鲁医院普外科收治的75例直肠癌患者的临床资料。患者随机分为两组:腹腔镜组和开腹组。腹腔镜手术组共33例,其中28例行直肠前切除术(Dixon术),5例行腹会阴直肠癌根治术(Miles术);开腹组42例,其中30例行Dixon术,12例行Miles术。比较两组的出血量、手术时间、并发症、术后恢复时间等指标。结果:腹腔镜组32例手术成功,1例中转开腹,平均手术时间200min(150～300min),术中平均出血100ml(30～400ml),术后肠功能平均恢复时间36h(24～50h),清除淋巴结10.9枚(4～20枚),术后4例切口感染,平均住院10.8d(7～19d)。开腹组平均手术时间140min(90～210min),术中平均出血170ml(80～500ml),术后肠功能平均恢复时间48h(36～72h),清除淋巴结12.3枚(4～19枚),术后6例切口感染,平均住院14.5d(9～22d)。两组在手术时间、出血量、术后恢复时间、手术并发症等方面差异均有统计学意义(P<0.01)。结论:腹腔镜直肠癌根治术具有明显的微创优势,安全可行,能达到开腹手术的根治效果。

The application of laparoscopic radical resection for rectal carcinoma

Objective:To investigate the mini-invasive advantages of laparoscopic radical resection of rectal carcinoma,so as to improve the curative effect of laparoscopic radical resection of rectal carcinoma and reduce its complications.Methods:The clinical data of 75 cases with rectal cancer from May 2002 to Oct.2007 were analyzed retrospectively.They were randomly divided into 2 groups-laparoscopy group and laparotomy group.There were 33 patients in laparoscopy group(28 Dixon and 5 Miles) and 42 cases in laparotomy group(30 Dixon and 12 Miles).The amount of hemorrhage,operative time,complications and postoperative recovery time were compared between two groups.Results:In laparoscopy group,32 operations were successful and only one case converted to open surgery,the average operative time was 200min(150-300min),the mean amount of hemorrhage was 100ml(30-400ml),the mean recovery time of intestinal function was 36h(24-50h),the mean number of lymph node harvest was 10.9(4-20),4 cases developed incision infection,the average hospitalization was 10.8d(7-19d).In laparotomy group,the average operative time was 140min(90-210min),the amount of hemorrhage was 170ml(80-500ml),the mean recovery time of intestinal function was 48h(36-72h),the mean number of lymph node harvest was 12.3(4-19),6 cases developed incision infection,and the average hospitalization was 14.5d(9-22d).There were significant differences between the two groups in operative time,the amount of hemorrhage,recovery time after operation and complications(P<0.01).Conclusions:Laparoscopic radical resection of rectal carcinoma is safe,feasible and minimally invasive,which acquires similar effect with open approach.