摘要
目的：比较腹腔镜与传统开腹全直肠系膜切除术（TME）治疗直肠癌的效果，探讨腹腔镜下TME治疗直肠癌应注意的问题。方法采用回顾性队列研究的方法，分析比较75例腹腔镜组患者与61例开腹手术组患者的围手术期相关指标及临床病理结果。结果腹腔镜组与开腹手术组患者的手术切口[8.7 cm（8.0～10.0 cm）比13.6 cm（10.0～16.0 cm）]、术后镇痛药使用（8例比23例）、术后拔除引流管时间[5 d（5～6 d）比6 d（6～8 d）]、术后开始下床活动时间[3 d（3～7 d）比5 d（4～8 d）]及术后住院时间[6 d（5～18 d）比8 d（6～25 d）]方面，差异均有统计学意义（均P＜0.05）。腹腔镜组的手术费用高于开腹组（平均每人多花费约7000元）。腹腔镜组与开腹手术组的总体并发症发生率差异有统计学意义[6.7%（5／75）比13.1%（8／61），P＜0.05]。结论腹腔镜TME在术后镇痛药的使用、拔除引流管时间及住院时间等指标上较开腹手术具有优势，但腹腔镜手术因使用高值耗材而较开腹手术的治疗费用高。腹腔镜直肠癌切除需慎重。
Objective To compare the efficacy of laparoscopic and conventional open total mesorectal excision （TME） in the treatment of rectal cancer, and to explore the considerations of laparoscopic TME. Methods 75 cases of laparoscopic group and 61 cases of open surgery group were analyzed retrospectively, and cohort study was used to compare the perioperative indicators and clinicopathological results in the two groups. Results Between the laparoscopic group and the open surgery group, the operative incision [8.7 cm （8.0-10.0 cm） vs. 13.6 cm （10.0-16.0 cm）], the use of postoperative analgesics （8 cases vs. 23 cases）, postoperative time to remove the drainage tube [5 d （5-6 d） vs. 6 d （6-8 d）], postoperative time to get out of bed [3 d （3-7 d） vs. 5 d （4-8 d）] and postoperative hospital stay time [6 d （5-18 d） vs. 8 d （6-25 d）] had statistical difference （all P〈0.05）. The cost of laparoscopic group was higher than that of open surgery group （each patient in laparoscopic group spent more about 7 000 yuan than ones in open surgery group ）. There was a significant difference in the overall complication rate between the laparoscopic group and the open surgery group [6.7 % （5/75） vs. 13.1 % （8/61）, P〈0.05]. Conclusions The postoperative analgesics, removal of drainage tube time, hospital stay and other indicators in the laparoscopic TME are superior compared with those in the open surgery, but due to the use of high-value consumables, the cost of laparoscopic surgery is higher. Besides, laparoscopic resection of rectal cancer should be careful.
作者
董博
黄博
董永红
毕小刚
王永刚
田利军
Dong Bo Huang Bo Dong Yonghong Bi Xiaogang Wang Yonggang Tian Lijun(Department of General Surgery, Shanxi Provincial People＇s Hospital, Taiyuan 030012, China Department of Anorectal Surgery, Shanxi Provincial People＇s Hospital, Taiyuan 030012, China)
出处
《肿瘤研究与临床》
CAS
2016年第10期679-682,共4页
Cancer Research and Clinic
基金
山西省卫生厅科技攻关计划（200940）
关键词
直肠肿瘤
全直肠系膜切除术
腹腔镜
Rectal neoplasms
Total mesorectal excision
Laparoscopy
