左半结肠癌腹腔镜和开腹根治术临床对照研究

目的评价腹腔镜辅助下左半结肠癌根治术与同期开腹手术在短期疗效方面的差异。方法回顾性分析解放军总医院普通外科2005年6月-2009年12月实施的89例左半结肠癌根治术的临床资料,其中腹腔镜组（LAP）38例,开腹组（OS）51例,对两组术后并发症以及复发、转移、生存等结果进行比较。结果腹腔镜组平均手术时间145min,其中2例中转开腹;开腹组平均手术时间178min。术中平均出血量腹腔镜组（78ml）明显少于开腹组（167ml）（P=0.025）;与开腹组相比较,腹腔镜组病例术后平均排气时间和平均住院天数均缩短（P=0.03,P=0.027）。平均随访28个月,两组3年累计存活率无统计学差异（P〉0.05）;与开腹组相比,腹腔镜组病例术后发生粘连性肠梗阻明显减少（P=0.047）。结论腹腔镜辅助下左半结肠切除术技术上安全可行,短期疗效与开腹组相似,但术后并发症较少。

Laparoscopic and open left hemicolectomy for descending colon cancer

Objective To study and evaluate the different short-time outcomes of laparoscopic（LAP） and open left hemicolectomy（OS） for descending colon cancer.Methods The clinical and follow-up data of 89 patients with descending colon cancer who underwent LAP or OS from June 2005 to December 2009 in our hospital were retrospectively analyzed.The patients were divided into LAP group（n=38） and OS group（n=51）.The complications,relapse,metastasis of descending colon cancer,and the survival time of patients were compared between the two groups.Results The mean operation time was 145 minutes for the LAP group and 178 minutes for the OS group.Two patients in the LAP group were converted to laparotomy.The intraoperative blood loss was significantly less in the LAP group than in the OS group（78ml vs 167ml,P=0.025）.The mean postoperative exsufflation time and hospital stay time were shorter in the LAP group than in the OS group（P=0.03,P=0.027）.The mean follow-up time was 28 months.No significant difference was observed in the 3-year cumulative survival rate between the two groups（P0.05）.The incidence of postoperative adhesive intestinal obstruction was significantly lower in the LAP group than in the OS group（P=0.047）.Conclusion LAP for descending colon cancer is a technically safe and feasible procedure,its short-term curative effect is similar to that of OS,and its complications are less than those of OS,and is thus worthy of popularization.