结直肠癌腹腔镜手术与开腹手术的短期疗效比较

 目的 评估腹腔镜治疗结直肠癌的短期疗效，探讨腹腔镜治疗结直肠癌的可行性、安全性、有效性。方法 自2004年1月至2009年3月，共有35名患者在我院接受了腹腔镜下结直肠癌手术，其中32例为根治性切除术（腹腔镜组）1例为探查术，2例中转开腹。随机选取同期相同数量的开腹手术患者作为开放组。回顾性统计、比较两组的短期疗效，包括手术时间、术中出血量、术中输血量、切口长度、组织病理学数据、术后并发症及术后功能恢复情况。结果腹腔镜组与开放组各为32例，其余3例（1例腹腔镜下探查术，2例中转开腹）独立分析。两组患者的性别、年龄、肿瘤位置及TNM分期无统计学差异。在组织病理学方面，两组无统计学差异（肿瘤切缘：5 cm vs 5 cm，P=0.664；清扫淋巴结数量：7 vs 8，P=0.228）。腹腔镜组与开放组在手术时间（250 min vs 180 min，P=0.006）、切口长度（10 cm vs 20 cm，P<0.001）、术中输血需要（1例 vs 10 例，P=0.003）、止痛剂使用量（12例 vs 25例，P=0.004）、术后住院天数（9.5 d vs 11 d，P=0.008）、术后肠道功能恢复情况等方面具有统计学差异；在术中出血量（200 mL vs 200 mL，P=0.098）、术后并发症发生率（8例 vs 6例，P=0.545）及术后引流量（507.5 mL vs 669.0 mL，P=0.475）等方面无统计学差异。结论 尽管病例数量有限，本回顾性分析显示，在肿瘤学安全性和短期疗效方面，腹腔镜下结直肠癌手术不亚于传统开腹手术。

Short-term outcomes of laparoscopy surgery for colorectal cancer: a comparative study

Objective To investigate the short-term outcomes and oncological safety of laparoscopy resection for colorectal cancer. Methods Between January 2004 and March 2009, 35 patients with colorectal cancer underwent laparoscopic-assisted surgery in our hospital, among which 32 underwent radical resection, 1 underwent laparoscopic exploration, and 2 were converted to open surgery. These patients were allocated in the laparoscopic group. Same numbers of patients who underwent conventional open surgery during the same period of time were identified and allocated in the open group. Short-term data, including surgical time, intra-operative blood loss, intra-operative blood transfusion, length of incision, histopathological data, post-operative complications and post-operative functions, were collected and compared between the two groups. Results A total of 67 patients were enrolled (32 in both laparoscopy and open groups). The other 3 cases were analyzed separately (1 underwent laparoscopic exploration and 2 converted to open surgery). The two groups were well balanced as to age, gender, and TNM staging and location of tumour. Histopathologically, the laparoscopic approach was equal to conventional approach as regard to resection margin (distal margin, 5 cm vs 5 cm, P=0.664) and lymph node yield (7 vs 8, P=0.228). This study also showed a longer surgical time (250 min vs 180 min, P=0.006), but shorter length of incision (10 cm vs 20 cm, P<0.001), less demand of intra-operative blood transfusion (1 case vs 10 cases, P=0.003), reduced use of analgesics (12 cases vs 25 cases, P=0.004), shorter post-operative stay (9.5 days vs 11 days, P=0.008) and earlier recovery of bowel function of the laparoscopic group. There was no statistical difference of intra-operative blood loss (200 mL vs 200 mL, P=0.098), incidence of post-operative complications (8 cases vs 6 cases, P=0.545) and volume of post-operative negative drainage (507.5 mL vs 669.0 mL, P=0.475) between the two groups. Conclusions Though limited by a relatively small sample size, our study showed that laparoscopy approach for colorectal cancer is equal to open approach in terms of oncological safety and short-term outcome.