腹腔镜辅助下直肠癌前切除67例临床治疗体会

目的探讨腹腔镜手术治疗直肠癌的临床应用价值。方法回顾分析腹腔镜辅助下直肠癌前切除67例患者与开腹行直肠癌前切除82例患者之间临床资料，比较两组患者手术时间、术中估计出血量、远切缘距离、淋巴结清扫数量、排气时间、进食时间、住院时间及术后并发症情况。统计分析用SPSS20．0软件，计量资料采用方差分析或非参数检验；计数资料采用Pearsonr检验。结果腹腔镜组和开腹组手术平均时间（195±54．5）min与（148±52．1）rain]，平均出血量（30．0±10．1）ml与（200±40．0）ml]，平均排气时间（3．0±1．0）d与（6．0±1．0）d]，平均进流食时间（4．0±1．0）d与（6．0±2.0）d]，平均住院时间（7．0±1．0）d与（12．0±1．2）d]，腹腔镜手术组优于开腹手术组（t值分别为：5．34、37．07、18．22、7．92、27．74，P〈0．05），两组差异有统计学意义。两组淋巴结清除数、术后并发症发生率及3年生存率差异无统计学意义（检验值分别为：t=1．77、r=0．17、χ^2=0．76，P〉0．05）。结论腹腔镜直肠癌前切除技术上是安全可行的，能满足肿瘤根治的要求，切口小、创伤小、出血少、胃肠道功能恢复快等优点已经逐渐被大家所公认。

Laparoscopy-assisted anterior resection in treating rectal cancer

Objective To explore the clinical value of laparoscopy-assisted anterior resection in treating patients with rectal cancer. Methods A retrospective analysis of clinical data of 149 patients with rectal cancers was performed. The patients comprised 67 cases of laparoscopy-assisted anterior resection from March 1,2010 to February 15,2013 （laparoscopy-assisted group） and 82 cases of open anterior resection of rectal cancer from January 1,2006 to May 31,2009 （laparotomy group）. The clinical data of the two groups were compared, including operation time, blood loss, distance from tumor to the lower ifieision margin, the number of harvested lymph nodes, exhaustion time, eating time, hospital stay and postoperative complications. SPSS20.0 software was used for statistical analysis, the measurement data were processed by analysis of variance （ANOVA） or non-parametric test, and the enumeration data were processed by Pearson rank-order test. Results Laparoscopy-assisted group was more advantageous than laparotomy group in terms of operation time （195：1： 54.5） rain vs. （148 ± 52.1） rain, blood loss （30.0 ± 10.1） ml vs. （200 ± 40.0） ml, exhaustion time （3.0 ± 1.0） d vs. （6.0 ± 1.0） d, time for liquid diet intake （4.0 ± 1.0）d vs. （6.0 ± 2.0）d, hospital stay length （7.0 ± 1.0）dvs.（12.0 ± 1.2）d （t=5.34, 37.07, 18.22, 7.92, 27.74 respectively P 〈 0.05 ）. There was no significant difference between the 2 groups, when the number of harvested lymph nodes, the incidence of postoperative complications and 3-year survival rate were compared （ t = 1.77 ,χ2 = 0. 17, χ2 = 0. 76 respectively, P 〉 0. 05 ）. Conclusions Laparoscopy-assisted anterior resection in treating rectal cancer is safe and feasible, and could meet the requirement of radical resection of tumors, with many advantages such as smaller abdominal incision, less invasion, earlier ambulation, less bleeding, faster recovery of gastrointestinal function.