腹腔镜低位直肠癌直肠前切除术的疗效观察

目的探讨腹腔镜超低位直肠癌直肠前切除术的安全性和临床疗效。方法分析2006年1月至2010年2月解放军第150中心医院全军肛肠外科研究所收治的145例采用低位直肠癌根治直肠前切除术的患者,其中腹腔镜手术84例(腹腔镜组),开腹手术61例(开腹组)。观察指标包括手术时间、术中出血量、淋巴结清扫数目、术后肛门排气时间、住院时间、术后并发症等。结果腹腔镜组和开腹组的一般临床病理资料比较差异无统计学意义(P>0.05)。两组均顺利完成手术,无与手术相关的死亡病例。腹腔镜组的手术时间略长于开腹组,但是差异无统计学意义(P>0.05);腹腔镜组的术中失血量明显少于开腹组,差异有统计学意义(P<0.05);腹腔镜组的术后肛门首次排气排便时间、恢复流质饮食时间、住院时间明显短于开腹组,差异均有统计学意义(P<0.05);腹腔镜组检出淋巴结枚数也明显多于开腹组,差异有统计学意义(P<0.05)。两组并发症发生率比较,差异无统计学意义(P>0.05)。两组患者的生存曲线比较,差异无统计学意义(χ2=2.356,P>0.05)。结论腹腔镜低位直肠癌直肠前切除术术中出血少、淋巴检出个数多,且创伤小、术后恢复快,比开腹直肠癌手术有更大优势。

Clinical effect of laparoseopic anterior resection for patients with low rectal cancer

ObjectiveTo evaluate the safety and clinical effect of laparoscopic anterior resection for patients with low rectal cancer.Methods145 patients underwent anterior resection for low rectal cancer in this hospital from January 2006 to February 2010 were analyzed, in which 84 patients underwent laparoscopic surgery （laparoscope group） and 61 patients underwent open surgery （open group）. All these data such as the survival time, operative time, intraoperative blood loss, harvested lymph nodes, the first anal exhaust time and liquid diet recovery time, postoperative hospitalization, and postoperative complications were collected and compared between the laparoscope group and laparotomy group.ResultsThe demography and clinicopathologic characteristics were similar （P〉0.05） between the two groups. The operation was successfully performed in all the patients. There was no death associated with the operation. Compared with the laparotomy group, the intraoperative blood loss was less （P〈0.05）, the first anal exhaust time and liquid diet recovery time, postoperative hospitalization were shorter （P〈0.05）, the harvested lymph node was more harvested lymph nodes （P〈0.05） in the laparoscope group. There were no significant differences in the operative time, postoperative complications and the survival curves between the two groups （P〉0.05）.ConclusionsCompared to open anterior resection for low rectal cancer, laparoscopic anterior resection for low rectum cancer has more advantages in less blood loss, more harvested lymph nodes and less trauma, faster postoperative recovery.