手助腹腔镜与开腹手术在低位直肠癌治疗中的应用

目的：比较腹腔镜与开腹手术行低位直肠癌根治术的近期疗效。方法：回顾性分析腹腔镜与开腹手术治疗低位直肠癌患者的临床资料，其中腹腔镜组51例，开腹组48例，比较两组资料在手术时间、术中出血量、肠系膜淋巴结清扫个数、肠道功能恢复时间（记排气时间）、留置导尿时间、进流食时间、术后住院时间、术后并发症发生率之间的差异。结果：腹腔镜与开腹组相比，术中出血量[（61.0±15.0） mL vs （135.8±13.9） mL，P＜0.01]、肠道功能恢复时间[（2.0±0.7） d vs （3.0±0.7） d，P＜0.01]、留置导尿时间[（3.5±1.0） d vs （5.9±1.2） d，P＜0.01]、进流食时间[（3.0±0.9） d vs （4.3±0.9） d, P＜0.01]、住院天数[（8.0±1.3） d vs （10.1±1.8） d, P＜0.01]、并发症发生率（7.8% vs 25%，P＜0.025），腹腔镜组均少于开腹组。手术时间[（167.1±26.9） min vs （138.6±17.7） min，P＜0.01]及住院费用[（3.3±0.5）万元vs （2.6±0.4）万元，P＜0.01]，腹腔镜组多于开腹组。两组在淋巴结清扫数目上差别无统计学意义[（14.1±1.6） vs （14.3±1.9），P=0.586]。结论：腹腔镜下低位直肠癌根治术近期疗效优于开腹组。

Comparative Study of Recent Curative Effect on Laparoscopic and Open Resection for Low Rectal Can-cer

Objective To compare the recent curative effect of laparoscopy and open surgery for low rectal cancer. Methods Retrospective analysis on the clinical data of laparoscopy and open surgery for low rectal cancer in our hospital between January 2009 and December 2012. Laparoscopic group have 51 cases , 48 cases are in the open group.Peri-operative indexes and results of postoperative follow-up were compared between the two groups. The data of the two groups were compared in the operation time, intraoperative blood loss, number of removed mesenteric lymph nodes , the intestinal function recovery time（Record the fart time）, urinary reten-tion time,eating flow food time,postoperative hospitalization time, and the difference between the incidence of postoperative complications. Results As compared to the open surgery group,the laparoscopy group had sig-nificantly less blood loss[（61.0 ± 15.0） mL VS （135.8 ± 13.9） mL,P〈0.01],shorter gastrointestinal recovery time [（2.0 ± 0.7） d VS （3.0 ± 0.7） d,P 〈0.01],shorter urinary retention time[（3.5 ± 1.0） d VS （5.9 ± 1.2） d,P 〈0.01], shorter eating flow food time[（3.0 ± 0.9） d VS （4.3 ± 0.9） d,P 〈0.01], shorter hospitalization time[（8.0 ± 1.3） d VS （10.1± 1.8） d,P〈0.01], longer operative time[（167.1 ± 26.9） min VS （138.6 ± 17.7） min,P〈0.01], higher hos-pitalization cost[（3.3 ± 0.5） VS （2.6 ± 0.4） the thousand yuan,P 〈0.01] . The incidence of complications of lapa-roscopy group was lower than open surgery group（7.8% vs 25%,P 〈 0.05）.No significant difference existed in the number of resected lymph notes between the two groups（ 14.1 ± 1.6 vs14.3 ± 1.9,P = 0.586）. Conclusion Laparoscopy for low rectal cancer has more advantages than open surgery in the recent curative effect.