腹腔镜结直肠癌根治术安全性的探讨

目的探讨腹腔镜技术应用于结直肠癌手术治疗的安全性。方法收集2004年3月至2006年6月长征医院完成的腹腔镜下结直肠癌根治术53例及同期开腹手术80例,对其临床资料进行对照分析。结果两组病例在年龄、性别和肿瘤部位、分期、分级、手术方式等方面的构成差异均无统计学意义;与开腹组相比,腹腔镜下右半结肠切除术、乙状结肠切除术、直肠前切除术及腹会阴联合切除术所需手术时间均较长(t值分别为7.12、12.43、6.95、4.53,P均<0.01);而腹腔镜下直肠前切除术及右半结肠切除术出血量较开腹手术少(t值分别为3.16、6.95,P均<0.01);术后肠功能恢复时间、术后镇痛时间、饮食恢复时间以及术后住院时间均优于开腹手术(t值分别为6.15、6.53、6.15、45.6,P均<0.01);而切除淋巴结数量、右半结肠和乙状结肠标本切除长度和切缘距离以及术后并发症发生率与开腹手术相比,差异均无统计学意义。腹腔镜直肠前切除术远切端距离比开腹组长(t=3.83,P<0.01);随访2～27(平均12)个月,两组均未发现切口转移,局部复发和远处转移差异无统计学意义。结论腹腔镜结直肠癌根治术创伤小,且不影响手术的彻底性。

Safety assess of laparoscopic colectomy for the treatment of colorectal carcinoma

Objective To evaluate the safety of laparoscopic colectomy for the treatment of colorectal carcinoma.Method From March 2004 to June 2006,laparoscopic radical resection was performed in 53 cases of colorectal carcinoma.Clinicopathological and follow-up data were collected and compared with those of 80 cases with comparable parameters,who underwent open surgery during the same period.Result There were no significant differences in patient's age,gender,tumor sites,stages and pathological classifications between the two groups.The operative time was longer(P<0.05)and the blood loss in the right hemicolectomy and rectal anterior resection was less(P<0.05)in the LC group.Patients in the laparoseopic colectomy group enjoyed faster GI function recovery (P<0.01),less need for postoperative analgesics and shorter hospital stay (P<0.01).There were no significant differences in lymphatic node dissection and tumor margin between the two groups.An average of 12 months foLlow-up found no incisional tumor metastasis in neither groups,and there were no statistical significance between the two groups in local recurrence and distant metastasis of the tumor.Conclusion Our data confirmed that laparoscopic colorectomy was safe and with benefits of minimally invasion and quick recovery.