腹腔镜与开腹低位直肠癌TME超低位保肛术88例非随机对比研究

目的：探讨腹腔镜TME超低位保肛术治疗低位直肠癌的安全性和可行性。方法：回顾2004年1月～2009年6月间我院普通外科低位直肠癌的腹腔镜TME超低位保肛手术的临床资料,并以其开腹手术作为对照,进行分析。结果：本组腹腔镜手术56例,开腹手术32例。88例手术均顺利完成。腹腔镜手术后发生吻合口漏3例,大便次数增加7例;开腹手术后发生吻合口漏2例,大便次数增加5例,均经保守治疗好转。无输尿管损伤、排尿障碍、大便失禁等其它并发症。腹腔镜的手术时间和淋巴结清除数在两组间的差别均无统计学意义（P〉0.05）。腹腔镜的术中出血量和术后腹腔引流量比开腹手术少,肛门排气时间和住院时间比开腹手术短（P〈0.05）。结论：腹腔镜TME超低位保肛术治疗低位直肠癌是安全、可行的,同时能体现手术的微创性。

Comparison of Clinical Course Between Laparoscopic and Open TME Ultra-low Sphincter-Saving Procedure for Low Rectal Cancer: None-randomized Controlled Trials with 88 Cases

Objective： To study the safety and feasibility of laparoscopic TME ultra-low sphincter-saving procedure for low rectal cancer. Method： The patients, clinical course between laparoscopic and open TME ultra-low sphincter-saving procedure were compared and analysed retrospectively, who suffered from low rectal cancer in the First Affiliated Hospital of Jinan University between January 2004 and June 2009. Results： 88 cases were selected in this study, including 56 laparoscopic Surgery（Laparoscopic group） and 32 open Surgery（open group）. All the operations were performed successfully. 3 cases experienced anastomotic leakage and 7 cases suffered increased frequency of stool in laparoscopic group, while 2 cases experienced anastomotic leakage and 5 cases suffered increased frequency of stool in open group. All these patients got recovered by conservative treatment at last. No other complications were experienced, such as ureteral ingury, dysuresia, fecal incontinence, and so on. There was no significant difference in term of operation time and volume of number of lymphonode dissection between these two group （p〉0.05）. The volume of bleeding and abdominal drainage was less while postoperative time of bowel gas passage and hospital stay was shorter in laparoscopic group than that in open group respectively （P〈0.05）. Conclusions： This study reveals that it is safe and feasible to perform laparoscopic TME ultra-low sphincter-saving procedure for low rectal carcinoma, and it presents the character of minimal invasion.