Pan Yi-fei, Zhang Xiao-hua, Jia Xin-jian, Qu Jin-miao, Xiang You-qun, Yang Kai, Lin Bao-rong, Zheng Xiao-feng, Zheng Jue
Department of Oncology, The First Affiliated Hospital, Wenzhou Medical College, Wenzhou 325000, China.
Zhonghua Wei Chang Wai Ke Za Zhi. 2007 May;10(3):253-6.
To assess the advantage and disadvantage of laparoscopic abdomino-perineal resection and open abdominoperineal resection for low rectal cancer.
Patients with low rectal cancer, collected from July 2003 to April 2006, were randomly divided into laparoscopic abdominoperineal resection group (37 cases) and open abdominoperineal resection group (37 cases). Operation time, number of lymph node removed, intra-operative blood loss, time to pass flatus, time to ambulate, time to discharge, complications, early recurrence, and economical cost were compared between the 2 groups.
All patients were performed successfully. For the first 10 patients, operation time of laparoscopic group was significantly longer than that of open group, but there was no significant difference between the 2 groups. Intra-operative blood loss of laparoscopic group was significantly less than that of open group, but it was reverse for the first 10 patients. There was no significant difference in time to pass flatus between the 2 groups. Time to ambulate in laparoscopic group was significantly earlier than that in open group. There was no significant difference in time to discharge between the 2 groups, but it was earlier for perineum closure in laparoscopic group. Relative complications of laparoscopic group, including pulmonary infection, abdominal wound infection or split, were significantly less than those of open group. There was no significant difference in number of lymph nodes removed, early recurrence between the 2 groups. Operation cost of laparoscopic group was significantly higher than that of open group, but there was no significant difference.
Advantages of laparoscopic abdominoperineal resection were characterized for not only minimal invasion and good cosmetic outcome but also less blood loss, complications, and earlier postoperative recovery. The operation time, total costs and oncological clearance of laparoscopic abdominoperineal resection patients were comparable with those of open procedure patients.
评估腹腔镜腹会阴联合切除术与开放性腹会阴联合切除术治疗低位直肠癌的优缺点。
收集2003年7月至2006年4月的低位直肠癌患者，随机分为腹腔镜腹会阴联合切除术组（37例）和开放性腹会阴联合切除术组（37例）。比较两组的手术时间、淋巴结清扫数目、术中出血量、排气时间、下床活动时间、住院时间、并发症、早期复发情况及经济成本。
所有患者手术均成功。前10例患者中，腹腔镜组手术时间显著长于开放组，但两组间无显著差异。腹腔镜组术中出血量显著少于开放组，但前10例患者情况相反。两组排气时间无显著差异。腹腔镜组下床活动时间显著早于开放组。两组住院时间无显著差异，但腹腔镜组会阴切口愈合时间更早。腹腔镜组的相关并发症，包括肺部感染、腹部伤口感染或裂开，显著少于开放组。两组淋巴结清扫数目、早期复发情况无显著差异。腹腔镜组手术费用显著高于开放组，但差异无统计学意义。
腹腔镜腹会阴联合切除术的优点不仅在于侵袭性小、美容效果好，还在于出血量少、并发症少、术后恢复早。腹腔镜腹会阴联合切除术患者的手术时间、总成本和肿瘤根治程度与开放手术患者相当。
