腹腔镜和开腹全直肠系膜切除术治疗165例直肠癌患者短期疗效的比较

目的 比较腹腔镜全直肠系膜切除术(total mesorectal excision, TME)和开腹TME治疗直肠癌的手术切除范围和短期疗效.方法 在2002年8月至2005年12月期间收治了165例直肠癌患者,由患者自由选择上述手术方式,比较两组病例手术标本的长度、直肠远切端距肿瘤下缘的距离、清扫的淋巴结数目、局部复发率、远处转移发生率和2年生存率.两组病例的平均随访时间均为26.9个月(6～46个月).结果 两组病例的一般情况和Dukes分期相似.腹腔镜组和开腹手术组手术标本的长度分别是24.4 cm和25.2 cm;直肠远切端距肿瘤下缘的距离分别是2.9 cm和2.7 cm;清扫的淋巴结数目分别是11.5枚和10.6枚;局部复发率分别是9.6%和11%;远处转移发生率分别是11.5%和14.6%;2年生存率分别是85.7%和78.8%;2年无瘤生存率分别是76.2%和69.7%.两组病例以上参数均无显著差异.结论 腹腔镜TME和开腹TME治疗直肠癌的手术切除范围和短期疗效相同.

Short-term outcome of laparoscopic versus open resections for rectal cancer in 165 unselected patients

Objective To compare the short-term results of rectal cancer treated either by laparoscopic or open total mesorectal excision(TME). Methods A series of 165 unselected consecutive patients with rectal cancer from August 2002 to December 2005, who decided to accept the laparoscopic or open TME, were included in this study. The following parameters were compared between the two groups: length of the surgical specimen, distance between the distal incisal edge of the rectum and the inferior margin of the tumor, the number of the lymph nodes resected, local recurrence rate, incidence of distant metastases, and 2 year survival rate. The mean follow-up period for both groups was 26.9 months (range, 6-46 months). Results Demographic data and Dukes stage were matched in two groups. The mean length of the resected specimens was 24.4 cm in the laparoscopic TEM group and 25.2 cm in the open TEM group. The distance from the distal incisal edge of the rectum to the inferior margin of the tumor was 2.9 cm in the laparoscopic TEM group and 2.7 cm in the open TEM group, and the mean number of lymph nodes scavenged was 11.5 in the laparoscopic TEM group and 10.6 in the open TEM group. The local recurrence rate after laparoscopic resection was 9.6%, as compared with 11% after open resection. Distant metastases occurred in 11.5% of the patients in the laparoscopic group, whereas it was 14.6% in the open group. Two year survival rate was 85.7% and disease free survival was 76.2% after laparoscopic resection and compared to 78.8% and 69.7% after open resection. All above parameters did not show statistically different between the two groups. Conclusion The oncologic resection and the early outcomes are comparable between the two surgical approaches.