腹腔镜与开放手术治疗直肠癌的临床对照研究

Sun Yandong, Wu Guohao, Zhang Bo, Jiang Yi, Han Yusong, He Guodong, Zhuang Qiulin, Qin Xinyu

Department of General Sugery, Zhongshan Hospital, Fudan University, Shanghai 200032, China.

Zhonghua Wei Chang Wai Ke Za Zhi. 2014 Apr;17(4):369-72.

OBJECTIVE

To evaluate the safety and short-term outcomes of laparoscopic-assisted surgery for rectal cancer by comparing the efficacy of laparoscopy and open surgery.

METHODS

Clinical data of patients with rectal cancer treated by laparoscopy or open surgery in Zhongshan Hospital from April 2011 to June 2012 were analyzed retrospectively, and the clinical outcomes between the two groups were compared.

RESULTS

Ninety-six rectal cancer patients undergoing laparoscopic surgery(LS) were enrolled. A total of 216 rectal cancer patients underwent open surgery(OS). There was no operative death in both groups. In LS and OS group, the overall completion rates of TME were 86.4%(83/96) vs. 89.3%(193/216)(P>0.05) respectively, and the overall anal reservation rates were 78.1%(75/96) vs. 75.0%(162/216)(P>0.05) respectively. The mean distance to proximal resection margin and distal resection margin respectively were (10.3±4.1) cm vs.(10.0±4.3) cm(P>0.05) and (3.4±0.9) cm vs. (3.6±1.4) cm(P>0.05) respectively. The mean number of harvested lymph nodes respectively were (12.8±5.2) vs.(13.7±6.4)(P>0.05). Compared to OS, LS presented less blood loss [(98.0±28.7) ml vs. (175.0±41.0) ml, P<0.05], shorter postoperative hospital stay [(9.4±4.9) d vs.(11.6±6.2) d, P<0.05], quicker postoperative recovery of bowel function[(2.7±0.9) d vs. (3.4±0.9) d, P<0.05], shorter postoperative time to intake semi-solid[(3.7±1.2) d vs. (4.4±1.5) d, P<0.05], less postoperative complications(15.6% vs. 25.9%, P<0.05), but longer operative time[(155.7±48.4) min vs. (120.0±26.7) min, P<0.05]. Postoperative follow-up was 6 to 24 months, and the local recurrence of LS and OS was 2.1% and 2.3%(P>0.05).

CONCLUSION

Laparoscopic surgery can obtain the same radical efficacy for rectal cancer as compared to open surgery.

目的

通过比较腹腔镜手术与开放手术的疗效，评估腹腔镜辅助直肠癌手术的安全性及短期疗效。

方法

回顾性分析2011年4月至2012年6月在中山医院接受腹腔镜手术或开放手术治疗的直肠癌患者的临床资料，并比较两组的临床疗效。

结果

纳入96例行腹腔镜手术（LS）的直肠癌患者。共有216例直肠癌患者接受了开放手术（OS）。两组均无手术死亡。在LS组和OS组中，全直肠系膜切除术（TME）的总体完成率分别为86.4%（83/96）和89.3%（193/216）（P>0.05），总体保肛率分别为78.1%（75/96）和75.0%（162/216）（P>0.05）。近端切缘和远端切缘的平均距离分别为（10.3±4.1）cm和（10.0±4.3）cm（P>0.05）以及（3.4±0.9）cm和（3.6±1.4）cm（P>0.05）。平均获取淋巴结数分别为（12.8±5.2）和（13.7±6.4）（P>0.05）。与OS相比，LS的术中出血量更少[（98.0±28.7）ml对（175.0±41.0）ml，P<0.05]，术后住院时间更短[（9.4±4.9）d对（11.6±6.2）d，P<0.05]，术后肠功能恢复更快[（2.7±0.9）d对（3.4±0.9）d，P<0.05]，术后进食半固体食物时间更短[（3.7±1.2）d对（4.4±1.5）d，P<0.05]，术后并发症更少（15.6%对25.9%，P<0.05），但手术时间更长[（155.7±48.4）min对（120.0±26.7）min，P<0.05]。术后随访6至24个月，LS组和OS组的局部复发率分别为2.1%和2.3%（P>0.05）。