腹腔镜辅助Dixon及Miles根治术治疗低位直肠癌的疗效比较

【摘要】〓目的〓探讨比较腹腔镜辅助Dixon根治术与腹腔镜辅助Miles根治术治疗低位直肠癌的可行性、安全性及疗效。方法〓回顾性分析我院在我院符合入组及排除标准的低位直肠癌腹腔镜手术患者,按照术式分为Dixon组(41例)和Miles组(42例)。分析两组患者的临床病理资料、手术质量、术后康复情况及预后、复发资料。结果〓Dixon组与Miles组的临床病理资料并无显著的统计学分布差异。尽管Dixon组的手术时间及术中出血量优于Miles组,但Miles组的术后费用显著少于Dixon组的患者。两组患者的术后获取淋巴结总数及获取阳性淋巴结个数无明显的差别,肠道功能恢复时间亦相近,差异无统计学意义。Dixon组术后总体并发症发生率为17.0%,吻合口瘘的发生率为7.3%,Miles组患者术后总体并发症的发生率为21.4%,与Dixon相比差异未具有显著的统计学意义(P>0.05)。Dixon组患者术后5年预期总体生存率为60.6%,与Miles组的56.2%相近,差异未见统计学意义(P>0.05)。在随访期间,Dixon与Miles组患者复发率无明显差异,分别为12.2%及11.9%。结论〓腹腔镜低位直肠癌Dixon根治术肿瘤根治程度与腹腔镜辅助Miles根治术无明显差别,安全可靠,长期生存预后不逊于Miles手术。

Comparison of clinical outcome between laparoscopic assisted Dixon and Miles radical surgery for low rectal cancer

Objective To compare the the therapeutical effect between laparoscopic assisted Dixon and Miles radical resection for low rectal cancer. Methods Eighty-three patients with low rectal cancer who received laparoscopic assisted surgery were included in the study according to the inclusion and exclusion criteria from January 2008 to December 2010. The enrolled patients were divided into two groups： Dixon group （41 cases） and Miles group （42 cases）. The clinicopathological data, surgical quality, postoperative survival and recurrence data were compared between two groups. Results There were no distribution differences in clinical data between Dixon group and Miles group. The mean operative time and intraoperative blood loss in Dixon group were shorter than that in Miles group （P〈0.05）, however the Miles group cost less postoperatively. No differences were found between two groups in the numbers of lymph nodes harvested postoperatively and positive lymph nodes. Both two groups had similar bowel function recover time. The overall postoperative complication rate in Dixon group was 17.0% and 21.4% in the Miles group （P〉0.05）. The postoperative 5-years overall survival rate of Dixon and Miles group was 60.6% and 56.2% respectively and no survival difference was found between them. During follow-up period, the recurrence rates between Dixon and Miles groups were similar （12.2% vs 11.9%, P〉0.05）. Conclusions Laparoscopic assisted Dixon radical opera-tion for low rectal cancer was a safe surgical procedure and had similar clinical effect with laparoscopic assisted Miles rectal surgery. The long-term survival outcome of laparoscopic assisted Dixon surgery was similar to laparoscopic assisted Miles surgery.