【摘要】 目的比较直肠癌经腹腔镜辅助和传统开腹全直肠系膜切除术(total mesorectal excision,TME)治疗直肠癌的可行性和短期临床疗效。方法 2005年8月至2009年4月期间同期收治了74例直肠癌患者,由患者自由选择上述手术方式,分为腹腔镜组(31例)和传统开腹组(43例),对其临床资料进行回顾性分析。比较两组病例手术时间,手术出血量,清扫的淋巴结数目,手术标本的长度,直肠远切端距肿瘤下缘的距离,术后肠道功能恢复时间,术后住院时间,术中和术后并发症。结果两组病例的一般情况和Dukes分期差异无统计学意义。两组均无手术死亡病例。腹腔镜组和开腹组手术时间分别为(181.61±45.65)min和(136.28±31.07)min,术中平均出血量分别为(141.61±54.52)mL和(234.42±73.72)mL,术后肠道功能恢复时间分别为(34.03±7.74)h和(79.28±10.43)h,术后住院时间分别为(11.81±3.04)d和(14.26±4.78)d,两组比较差异均有统计学意义(P<0.05)。清扫的淋巴结数目分别为(10.64±3.03)个和(11.44±3.43)个,直肠远切端距肿瘤下缘的距离分别是(3.59±0.67)cm和(3.53±0.79)cm,切除标本的长度分别是(22.01±3.42)cm和(23.58±3.67)cm,两组病例以上参数差异均无统计学意义(P>0.05)。腹腔镜组术中和术后并发症发生率为6.5%(2/31)和12.9%(4/31),开腹组分别为4.7%(2/43)和16.3%(7/43),两组比较差异无统计学意义(P>0.05)。结论腹腔镜辅助下全直肠系膜切除术治疗直肠癌是安全、可行的,可完全获得与传统开腹手术相似或更优的短期疗效。更多还原

【Abstract】 Objective To evaluate the feasibility of laparoscopical assisted total mesorectal excision(TME) of carcinoma of rectal and to compare the short-term effect of laparoscopical procedure with conventional open surgery for carcinoma of rectal.Methods A series of 74 unselected consecutive patients with carcinoma of rectal from August 2005 to April 2009,who decided to accept the laparoscopical assisted or conventional open TME,were included in this study,the patients with a free choice by way of the above-mentioned operation were divided into laparoscopical TME group(31 cases) and open TME group(43 cases).The following parameters were compared between these two groups;operative time,surgical blood loss,number of the lymphnodes resected,length of the surgical specimen,distance from the distal incisal edge of the rectum to the inferior margin of the tumor,time to passage of first flatus,postoperative hospital stay and perioperative complications.Results Demographic data and Dukes stage were matched.No surgery-related death occurred during perioperative period in two groups.The mean operative time was 181.61 minutes in the laparoscopic TME group,which was significantly more than that of open group,but the mean surgical blood loss,postoperative hospital stay,and lime to passage of first flatus were 141 ml,11.81 days and 34.03 hours respectively,which were significantly less than those of open group(P <0.05).The mean number of lymphnodes scavenged was 10.64 in the laparoscopic TME group and 11.44 in the open TME group,the mean length of the resected specimens was 22.01 cm in the laparoscopic TME group and 23.58 cm in the open TME group,and the distance from the distal incisal edge of the rectum to the inferior margin of the tumor was 3.59 cm and 3.53 cm in the laparoscopic TME group and open TME group respectively,all above parameters did not show statistically different between the two groups(/J>0.05).In the laparoscopic group intraoperative and postoperative complication rate was 6.5%(2/31) and 12.9%(4/31),as compared with 4.7%(2/43) and 16.3%(7/43) in the open surgery group,the two groups was no significant difference(P > 0.05).Conclusions Laparoscopical-assisled TME for rectal carcinoma is safe and feasible,the oncologic resection and the short-term effect are comparable between the two surgical approaches.更多还原