手辅助腹腔镜与腹腔镜外科治疗结直肠癌的临床疗效观察

目的 比较手辅助腹腔镜与腹腔镜外科在结直肠肿瘤根治手术中的临床疗效,并探讨手辅助腹腔镜的手术安全性及适应证。方法 前瞻性选取2009年11月至2010年12月中山大学附属第一医院胃肠外科64例结直肠癌患者,随机数字表法分为2组,每组32例,分别进行手辅助腹腔镜及腹腔镜于术治疗。比较2组患者的临床病理特点、手术安全性、根治程度及术后恢复情况。结果 64例结直肠癌患者无中转开腹手术,无死亡病例。2组年龄、性别、体质指数、肿块大小等临床病理特点差异均无统计学意义（均P ＞0.05）。手辅助组手术时间明显短于腹腔镜组[(127±31) min比(184 ±71) min,P=0.022];术中出血量及术后48 h平均引流量均明显高于腹腔镜组[(150±42) ml比(82 ±31) ml、(208±58)ml比(170±52) ml,P=0.008、0.020];Trocar使用数少于腹腔镜组（2.4个比5.0个,P=0.015）。腹腔镜组和手辅助腹腔镜组在肠段切除长度[(19±5)cm比(18±4)cm]、淋巴结清扫数量[(16±4)个比(16±3)个]、术后并发症发生率[12.5％ (4/32)比25.0％(8/32)]、术后排气时间[(1.7±0.9)d比(1.8±0.7)d]、术后耐受半流时间[(2.9±1.3)d比(2.8±1.2)d]、住院费用[（4.8±0.6）万元比（4.9±0.4）万元]及术后住院时间[(6.7±2.3)d比(6.6±2.3)d]等方面,差异均无统计学意义（均P ＞0.05）。结论 手辅助腹腔镜手术治疗结直肠癌可以保证手术的安全有效性,是结直肠癌于术治疗的良好术式之一。

Comparison of clinical outcomes between laparoscopic-assisted and hand-assisted laparoscopic operations in colorectal cancer

Objective To compare the clinical outcomes of laparoscopic-assisted versus handassisted laparoscopic radical operations in colorectal cancer and evaluate the safety and indications of handassisted laparoscopic operations. Methods A total of 64 consecutive colorectal cancer patients enrolled from November 2009 to December 2011 at our hospital were randomly and prospectively divided into 2 groups: hand-assisted laparoscopic operation (HALS) ( n =32) and laparoscopic-assisted operation ( n =32). And such clinicopathologic features as safety, operative curability and postoperative recovery were compared between two groups. Results Neither death nor conversion-to-open-surgery was reported among all patients. There were no statistical differences in such clinicopathologic features as age, gender, body mass index, mass size and location( all P ＞0.05 ). There were statistically a shorter operation time [( 127 ±31 ) min vs ( 184 ± 71 ) min, P =0.022] and a smaller number of Trocar(2.4 vs 5.0, P =0.015 ) in the HALS group. However, the laparoscopic-assisted group had a lesser volume of blood loss [(82 ±31 ) ml vs ( 150 ±42) ml, P =0.008] and a smaller postoperative 48 h drainage flow [( 170 ±52) ml vs (208 ±58)ml, P =0.020]. Moreover, no statistical differences existed in the length of bowel resection [(19 ±5) cm vs (18 ± 4) cm], amount of lymph nodes dissection (16 ± 4 vs 16 ± 3), postoperative complications [12.5％(4/32) vs25.0％ (8/32)], time of intestinal function recovery [(1.7 ±0.9) d vs (1.8 ±0.7) d], time of semifluid tolerance [(2.9 ± 1.3) vs (2.8 ± 1.2) d], hospitalization expenses [(4.8 ±0.6 ) 10000 yuan vs ( 4.9 ± 0.4 ) 10000 yuan] and postoperative hospital stay [( 6.7 ± 2.3 ) d vs ( 6.6 ±2.3 ) d] ( all P ＞ 0.05 ). Conclusion HALS is both safe and efficacious for colorectal cancer patients.