腹腔镜与开腹低位直肠癌根治术的疗效对比*

    万伯顺1陈跃宇1史佩东1杨伟强1钟鸣2(1 上海市嘉定区中心医院上海201899;2 上海交通大学医学院附属仁济医院上海200127)

    [摘要]目的评估腹腔镜手术治疗低位直肠癌的临床应用价值、疗效以及安全性。方法回顾性分析2006年10月至2012年10月在上海市嘉定区中心医院行低位直肠癌根治术的患者143例，根据手术方式分为腹腔镜组(69例)和开腹组(74例)，比较两组围手术期及术后生存率情况。结果腹腔镜组和开腹组在年龄、性别、病理类型、肿瘤分化、肿瘤分期等方面差异均无统计学意义(P>0.05)；腹腔镜组手术时间(171.4±63.6 min)大于开腹组(146.1±47.1 min)，术中出血量(63.4±23.6 mL vs. 92.6±31.8 mL)、术后排气时间(2.5±1.3 d vs. 3.6±1.1 d)、术后留置导尿管时间(4.6±1.9 d vs. 6.3±2.2 d)腹腔镜组均小于开腹组，腹腔镜组术后总并发症的发生率与开腹组相似(7.0% vs 13.2%)(P>0.05)，术后吻合口漏率、肺部感染、切口感染、泌尿系感染两组差异无统计学意义；术后随访时间12～60个月，中位随访时间54个月，腹腔镜组和开腹组在术后1年、3年、5年的生存率、无瘤生存率和局部复发率等方面差异均无统计学意义(P>0.05)。结论腹腔镜手术治疗低位直肠癌是安全可行的，其远期疗效和开腹手术相似，在对盆腔神经丛的保护和对低位直肠癌的保肛方面可能更有优势，值得推广。

    [关键词]腹腔镜；低位直肠癌；全直肠系膜切除术

    [中图分类号]R735.3[文献标志码]A

    [收稿日期：2014-11-05]

    基金项目：*南宁市科技局科研项目(201013045C-7)

    通讯作者△

    Comparison of efficacy between laparoscopic and open radical resection for low rectal cancer

    Wan Boshun,Chen Yueyu,Shi Peidong,et al.(Jiading District Central Hospital，Shanghai 201899)

    Abstract[]Objective To evaluate the clinical efficacy of laparoscopic surgery for low rectal cancer. Methods Clinical date of 143 patients with low rectal cancer who underwent radical resection from October 2006 to August 2012 in Jiading District Center Hospital was analyzed retrospectively. The patients were divided into two groups: the laparoscopic surgery group and open surgery group, and the perioperative details and postoperative survival rate were compared. Results There was no significant differences in age, sex, pathological type, tumor differentiation and TNM staging. The average operating time of laparoscopic surgery group(171.4±63.6min) was longer than that of open surgery group(146.1±47.1min),while the intraoperative blood loss, postoperative passage of flatus and indwelling catheter time in laparoscopic surgery group were significantly shorter than open surgery group. There was no difference in postoperative complications between laparoscopic surgery group and open surgery group. The patients were followed up for 12 to 60 months with a median of 54 months, and there were no significant differences in 1-year、3-year and 5-year survival、disease free survival and local recurrence between the two groups(P>0.05). Conclusion The laparoscopic surgery for low rectal cancer is feasible and safe. It has the same long-term outcome as open surgery, and it has advantages in preserving the pelvic nerve complex and preserving the anal sphincter for super low rectal cancer. Therefore, it is worthy of recommendation. ......