Yang Qingqiang, Xiu Peng, Qi Xiaolong, Yi Guoping, Xu Liang
Department of General Surgery, Affiliated Hospital of Luzhou Medical College, Luzhou, China.
JSLS. 2013 Apr-Jun;17(2):212-8. doi: 10.4293/108680813X13654754534675.
The confines of the narrow bony pelvis make laparoscopic surgery more challenging in the treatment of low rectal cancer. Macroscopic evaluation of the completeness of the mesorectum provides detailed information about the quality of surgery. This study was performed to observe the short-term outcomes and evaluate the macroscopic quality of specimens acquired from laparoscopic total mesorectal excision versus open total mesorectal excision in patients with low rectal cancer.
A total of 177 patients with low rectal cancer underwent total mesorectal excision by either a laparoscopic (n = 87) or open (n = 90) approach. In all cases the surgical time, blood loss, intraoperative and postoperative complications, postoperative bowel opening, and hospital stay were assessed. Special attention was given to the macroscopic judgment concerning the cut edge of peritoneal reflection, Denonvilliers fascia, completeness of the mesorectum, and bowel wall below the mesorectum.
The surgical time was 160 ± 40 minutes in the laparoscopic group. It was not significantly different from that in the open group (P = .782). The operative blood loss was 28 ± 5 mL in the group undergoing laparoscopic surgery and 80 ± 20 mL in the group undergoing open surgery (P < .01). Intraoperative injuries to the pelvic autonomic nervous system were recorded in 4 cases in the laparoscopic group compared with 12 cases in the open group (P < .05). The incidences of chest infection and anastomotic leakage were similar between the 2 approaches. The postoperative bowel opening time was 2.1 ± 1.5 days in the laparoscopic group and 3.5 ± 1.6 days in the open group (P < .01), whereas the hospital stay was 5.2 ± 1.8 days and 7.0 ± 2.1 days, respectively (P < .01). Intact Denonvilliers fascia and complete total mesorectal excision were more likely to be achieved by the laparoscopic approach than the open approach (P < .01). Colorectal anastomoses were located significantly lower in the laparoscopic group than in the open group (P < .01).
Laparoscopic total mesorectal excision has consistent advantages over open total mesorectal excision, including similar surgical time, less blood loss, reduced hospital stay, and shorter disability period. A complete macroscopic specimen is more likely to be acquired by laparoscopy because of the better pelvic view offered by the approach.
狭窄骨盆的解剖结构使腹腔镜手术治疗低位直肠癌更具挑战性。直肠系膜完整性的宏观评估可为手术质量提供详细信息。本研究旨在观察低位直肠癌患者行腹腔镜全直肠系膜切除术与开腹全直肠系膜切除术的短期疗效，并评估所获取标本的宏观质量。
共有177例低位直肠癌患者接受了全直肠系膜切除术，其中腹腔镜手术组（n = 87），开腹手术组（n = 90）。评估所有病例的手术时间、出血量、术中及术后并发症、术后肠道通气时间和住院时间。特别关注腹膜返折切缘、Denonvilliers筋膜、直肠系膜完整性及直肠系膜以下肠壁的宏观判断。
腹腔镜组手术时间为160±40分钟，与开腹组相比差异无统计学意义（P = 0.782）。腹腔镜手术组术中出血量为28±5 mL，开腹手术组为80±20 mL（P < 0.01）。腹腔镜组有4例记录有术中盆腔自主神经系统损伤，开腹组有12例（P < 0.05）。两种手术方式的肺部感染和吻合口漏发生率相似。腹腔镜组术后肠道通气时间为2.1±1.5天，开腹组为3.5±1.6天（P < 0.01），住院时间分别为5.2±1.8天和7.0±2.1天（P < 0.01）。与开腹手术相比，腹腔镜手术更有可能完整保留Denonvilliers筋膜并完整切除直肠系膜（P < 0.01）。腹腔镜组结直肠吻合口位置明显低于开腹组（P < 0.01）。
腹腔镜全直肠系膜切除术相对于开腹全直肠系膜切除术具有持续优势，包括手术时间相近、出血量少、住院时间缩短和功能恢复时间短。由于腹腔镜手术能提供更好的盆腔视野，因此更有可能获得完整的宏观标本。
