腹腔镜直肠癌手术的疗效分析

目的 探讨腹腔镜直肠癌手术的安全性和临床疗效.方法 前瞻性分析2004年5月至2008年7月山西省肿瘤医院收治的347例直肠癌患者的临床资料.采用抽签法将患者分成腹腔镜组和开腹组,其中3例自动退出试验,1例腹腔镜组患者中转开腹剔除本试验,最终169例纳入腹腔镜组,174例纳入开腹组.观察指标包括肿瘤直径,淋巴结清扫数目,标本切除长度,平均手术时间,术中输血例数,术后下床活动时间,术后肛门排气、排便和进食流质食物时间,并发症等.统计分析遵循意向治疗原则,采用Kaplan-Meier法计算生存率,t检验和x2检验分析数据.结果 腹腔镜组与开腹组患者的肿瘤直径、淋巴结清扫数目、标本切除长度和术中输血例数分别为(4.3±1.3)cm、(7±5)枚、(19.1±2.2)cm、4例和(4.2±1.3)cm、(7±5)枚、(19.0±2.3)cm、8例,两组比较,差异无统计学意义(t=0.629,-0.726,0.562,x2=1.264,P＞0.05).腹腔镜组平均手术时间比开腹组长19 min,两组比较,差异有统计学意义(t=7.904,P＜0.05).腹腔镜组患者术后下床活动时间、术后肛门排气时间、术后排便时间和进食流质食物时间与开腹组比较,分别提前0.6、0.3、0.3、0.6 d(t=-6.392,-3.581,-3.802,-3.493,P＜0.05).两组术后感染、吻合口漏、肠梗阻和深静脉血栓等并发症比较,差异无统计学意义(x2=0.236,0.354,0.000,0.000,P＞0.05).截至2010年5月1日,腹腔镜组和开腹组分别有167例和172例患者获得随访.腹腔镜组和开腹组患者1年生存率分别为94.0%和95.3%,2年生存率分别为82.6%和91.2%,两组患者2年生存率比较,差异无统计学意义(x2=0.541,P＞0.05).腹腔镜组和开腹组患者平均生存时间分别为55.9个月和57.9个月.结论 腹腔镜直肠癌手术创伤小,术后恢复快,安全有效.

Efficacy of laparoscopic surgery for rectal cancer

Objective To investigate the safety and clinical outcome of laparoscopic resection of rectal cancer. Methods The clinical data of 347 patients with rectal cancer who were admitted to the Shanxi Tumor Hospital from May 2004 to July 2008 were prospectively analyzed. Of all the patients, 343 met the inclusion criteria,and they were randomly allocated to laparoscope group (n = 169) and open group (n= 174). The diameter of the tumors, number of lymph node dissected, length of rectum resected, morbidity, the mean operation time, number of patients receiving blood transfusion, time to out-of-bed activity, first flatus, bowel movement and liquid diet were observed. All data were analyzed using the t test and chi-square test. The survival rate was calculated using the Kaplan-Meier method. Results The diameter of the tumors, number of lymph node dissected, length of rectum resected and number of patients receiving blood transfusion in the laparoscope group were (4.3 ± 1.3 ) cm, 7 ± 5,(19.1±2.2)cm and 4, and they were (4.2±1.3)cm, 7 ±5, (19.0±2.3)cm and 8 in the open group,respectively, with no significant difference between the two groups ( t = 0. 629, - 0. 726, 0. 562, x2 = 1. 264,P ＞0.05). The mean operation time in the laparoscope group was 19 minutes longer than that in the open group (t = 7. 904, P ＜ 0.05 ). The time to out-of-bed activity, first flatus, bowel movement and liquid diet in the laparoscope group were 0.6, 0.3, 0.3 and 0.6 days earlier than those in open group( t = - 6. 392, - 3.581, - 3. 802,- 3. 493, P ＜ 0.05 ). There were no significant differences in postoperative infection, anastomotic leakage, intestinal obstruction and deep vein thrombosis between the two groups ( x2 = 0. 236, 0. 354, 0. 000, 0. 000, P ＞0.05). A total of 167 patients in the laparoscope group and 172 patients in the open group had been followed upuntil 1 may, 2010. The 1-, 2-year survival rates were 94.0% and 82.6% in the laparoscope group and 95.3% and 91.2% in the open group. There was no significant difference in the 2-year survival between the two groups (x2 =0.541, P ＞0.05). The survival time of the patients in the laparoscope group and open group were 55.9 and 57.9 months, respectively. Conclusions Laparoscopic surgery is safe and feasible for patients with rectal cancer, with quick recovery after the operation.