开腹直肠癌根治术中应用腹腔镜器械与传统手术的对照研究

目的探讨腹腔镜器械（超声刀和腔镜直线型切割缝合器）在开腹直肠癌根治术中的临床应用价值。方法回顾性分析2009年6月～2011年6月70例开腹直肠癌根治术的临床资料,前35例使用腹腔镜器械,后35例使用开腹器械。观察2组的手术时间、术中出血量、术后排气时间、术后住院时间、术后并发症以及低位直肠癌保肛率的差异。结果与开腹器械组相比,腹腔镜器械组手术时间短（123.9±23.4）min vs.（141.6±33.5）min,t=-2.566,P=0.012],术中出血少（65.7±30.3）ml vs.（101.7±69.8）ml,t=-2.798,P=0.007],术后住院时间短（11.7±1.1）d vs.（13.1±1.3）d,t=-4.855,P=0.000],低位直肠癌的保肛率高85.7%（12/14）vs.23.1%（3/13）,P=0.002]。2组术后并发症发生率相近0%（0/35）vs.11.4%（4/35）,P=0.114]。结论腹腔镜器械（超声刀和腔镜直线型切割缝合器）在开腹直肠癌根治术中具有很好的应用前景。

Comparison between Laparoscopic and Conventional Surgical Instruments in Open Radical Resection of Rectal Carcinoma

Objective To evaluate the clinical value of laparoscopic instruments including ultrasonic scalpel and endoscopic linear cutter in open surgery for radical resection of rectal carcinoma.Methods We retrospectively reviewed the data of 70 patients who received open radical resection for rectal carcinoma from June 2009 to June 2011.Among the patients,laparoscopic instruments were used in 35 cases(laparoscopic group),while conventional surgical instruments were employed in the other 35(conventional group).The operation time,intraoperative blood loss,postoperative recovery time of gastrointestinal function,hospital stay,and complications,as well as the anal sphincter preservation rate in patients with low rectal cancer were compared between the two groups.Results The laparoscopic group showed significantly shorter operation time,less intraoperative blood loss,shorter postoperative hospital stay,and higher anal sphincter preservation rate than the conventional group (123.9±23.4) min vs.(141.6±33.5) min,t=-2.566,P=0.012;(65.7±30.3) ml vs.(101.7±69.8) ml,t=-2.798,P=0.007;(11.7±1.1) d vs.(13.1±1.3) d,t=-4.855,P=0.000;and 85.7%(12/14) vs.23.1%(3/13),P=0.002].No significant difference existed between the two groups in the rate of postoperative complications 0(0/35) vs.11.4%(4/35),P=0.114].Conclusion Laparoscopic instruments,including ultrasonic scalpel and endoscopic linear cutter,is promising in the open surgery for radical resection of rectal carcinoma.