腹腔镜直肠全系膜切除治疗中低位直肠癌的前瞻性非随机对照研究

目的：通过与开腹直肠全系膜切除的前瞻性非随机对照研究，评价腹腔镜TME治疗中低位直肠癌的临床疗效。方法：将2001年9月至2005年3月我院外科收治的中低位直肠癌病人，按纳入与剔除标准非随机分为腹腔镜组和开腹组，进行对照分析。结果：人组病例共251例，腹腔镜组和开腹组分别为110例和141例。腹腔镜组的中转开腹率为1．82％。腹腔镜组的平均手术时间、手术切除范围、术后并发症的发生率以及住院天数和开腹组均无显著性差异，而术中出血量、术后肠道功能的恢复要优于开腹组。中位随访期为28（11-57）个月，随访期内两组病例的局部复发率、远处转移率及无瘤生存率均无显著性差异。结论：腹腔镜TME治疗中低位直肠癌是安全、可行的．可以获得和传统开腹手术相同的中长期疗效，且在术后恢复上明显优于传统开腹手术。

Laparoscopic vs open total mesorectal excision for middle and low rectal cancer: a prospective non-randomized study

Objective To evaluate the feasibility and efficacy of laparoscopic total mesorectal excision (TME) in treating middle and low rectal cancer. Methods From Sep. 2001 through Mar. 2005, 251 patients with middle and low rectal cancer admitted were divided into laparoscopic group and open surgery group. Their clinical data and follow-up results were reviewed. Results Of all the 110 patients in the Lap group, 2 cases (1.82%) were converted to open surgery. No significant differences were observed in terms of mean operation time, extent of resection, post-operative complications, and duration of hospital stay between the two groups. The quantity of mean intraoperative blood loss, and the quality of post-operative recovery were better in the Lap group. The median follow-up period was 28 (11-57) months. The local recurrence and disease-free survival had no marked difference between the two groups. Conclusions Laparoscopic TME for middle and low rectal cancer is feasible and shows a better recovery as compared to conventional laparotomy. The long-term outcome shows no remarkable difference between the two groups.