腹腔镜手术治疗中晚期结直肠癌对比开腹手术的临床研究

目的 探讨腹腔镜手术治疗中晚期结直肠癌的可行性、安全性及治疗优势.方法 采用与同期开腹手术相比较的方法,将行中晚期结直肠癌切除的患者分为腹腔镜组(57例)和开腹组(56例),比较两组围手术期情况、不能够切除肝转移癌灶的处理情况及标本的临床病理结果,评价各组的肿瘤根治性、手术安全性、术后恢复情况及随访结果.结果 腹腔镜组术中出血量、术后离床时间、肛门排气时间、术后住院日数及术后并发症均明显减少(P＜0.05)；术后应用吗啡镇痛的剂量明显减少(P＜0.01)；腹腔镜下能够完成传统开腹手术肝转移癌灶的不同处理(P＞0.05)；肿瘤根治性相关临床病理学结果提示两组病例完全可以达到相同的根治程度(P＞0.05);两组在局部复发和病死率方面差异无统计学意义(P＞0.05).结论 腹腔镜行中晚期结直肠癌切除术创伤小,术后恢复快,根治性确切,具有可行性、安全性及微创优势,急诊手术亦是可行的.

Clinical study of laparoscopic radical operation on medium-term and terminal colorectal carcinoma

Objective To observe the possibility,safety and advantage of the laparoscopic operation on medium-term and terminal colorectal carcinoma.Methods The patients with colon and rectal carcinoma were divided into the laparoscopic group(n=57,lapa group) and open operation group(n=56,ope group).To compare the operation safety,recovery,complications,expenditure,lymph nodes clearance and short term outcome between two groups.Results The blood loss was obviously diminution,antinociceptive drugs was obviously decrease in lapa group(P<0.05).Time to resume early activity and hospital stay in lapa group were significantly shorter than those in ope group(P<0.05).Clinical pathology finding showed the same radical cure for the two groups and similar complications in the two groups(P>0.05).We did the same therapy in lapa group for the hepatic metastasis(P>0.05),no significant difference between the two groups was observed for the local recurrence and mortality(P>0.05).Conclusion Laparoscopic radical carcinosectomy on patients with the medium-term and terminal colorectal cancer has small wound,and recover quickly after the operation,effect a radical cure for good,which is possible and performed safely,effectively with the advantages of minimal invasiveness.