摘要
目的探讨腹腔镜和开腹低位直肠癌根治术对低位直肠癌临床疗效差异。方法选取2012年3月至2014年3月于河南省人民医院胃肠外科行腹腔镜低位直肠癌根治术的65例患者（腹腔镜组）与同期行开腹低位直肠癌根治术的53例患者（开腹组）的临床资料进行回顾性分析。比较2组患者手术时间、术中出血量、术后腹腔引流量、术后肛门首次排气时间、术后住院时间、淋巴结清扫数目、保肛率及术后并发症发生情况。结果2组患者手术时间和淋巴结清扫数目比较，差异无统计学意义（P〉0．05）。腹腔镜组术中出血量和术后腹腔引流量少于开腹组[（92±51）ml比（143±83）ml，（169±45）m1比（195±58）ml]，术后肛门首次排气时间和住院时间短于开腹组[（2．5±0．7）d比（3．3±0．5）d，（8．7±1．3）d比（9．6±2．1）d]，差异均有统计学意义（均P〈0．05）。腹腔镜组65例患者均成功完成腹腔镜下手术，其中63例完成直肠前切除术，2例术中发现远端切缘肿瘤细胞阳性改行腹会阴联合切除术；开腹手术组10例改行腹会阴联合切除术。腹腔镜组保肛率明显高于开腹组[96．9％（63／65）比81．1％（43／53）]，差异有统计学意义（P〈0．05）。腹腔镜组手术后发生吻合口漏4例，大便次数增加8例，开腹组手术后发生吻合口漏3例，大便次数增加7例，均经保守治疗好转；2组均无输尿管损伤、排尿障碍、大便失禁等其他并发症。结论腹腔镜下低位直肠癌根治术与传统开腹低位直肠癌根治术比较疗效安全可靠，并不增加手术并发症发生率，且创伤小、恢复快；另外，腹腔镜手术在低位保肛方面有明显优势。
Objective To compare the effect of laparoscopy and laparotomy radical resection in treating low rectal cancer. Methods Totally 118 patients with low rectal cancer from March 2012 to March 2014 underwent laparoscopy radical resection （ laparoscopy group, 65 cases ） and ]aparotomy radical resection （ laparotomy group, 53 cases）. The operation duration, blood loss, volume of abdominal drainage, time of gastrointestinal recovery, length of hospitalization, number of lymph nodes dissected, rate of sphincter-preserving, postoperative complications were analyzed and compared between the two groups. Results There were no significant differences regarding operation duration and number of lymph nodes dissected between groups （P 〉 0.05）. The volume of bleeding and abdominal drainage were less, time of gastrointestinal recovery and length of hospitalization were shorter in laparoscopy group than those in laparotomy group [ （92 ± 51 ） ml vs （143 ± 83 ） ml, （169 ±45 ） ml vs （195 ± 58） ml, （2.5±0.7） dvs （3.3±0.5） d, （8.7±1.3） dvs （9.6±2.1） d] （P〈0.05）. The operation was finished successfully in all the 65 patients in laparoscopy group, including 63 anterior resection and 2 abdominoperineal resection; 10 cases received abdomino-perineal resection in laparotomy group. The rate of sphincterpreserving in laparoscopy group was significantly higher than that in laparotomy group [ 96. 9% （ 63/65 ） vs 81.1% （43/53） ] （P 〈 0.05 ）. Four cases had anastomotic leakage and 8 cases had increased frequency of stool in laparoscopy group, 3 cases had anastomotic leakage and 7 cases had increased frequency of stool in laparotomy group; all the patients got recovery after conservative treatment. No other complications, such as ureteral ingury, dysuresia, fecal incontinence occurred in both groups. Conclusion Laparoscopy radical resection is safer and feasible with less injury and shorter recovery time compared with laparotomy in treating low rectal cancer, while without inc
出处
《中国医药》
2015年第12期1789-1791,共3页
China Medicine
