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[目的]比较腹腔镜全直肠系膜切除术(TME)与传统开腹直肠癌根治术在直肠癌保肛治疗中的应用效果。[方法]选取2009年6月至2011年2月在宁波市第二医院确诊为直肠癌的患者101例,分为腹腔镜组(49例)和开腹组(52例)。[结果]腹腔镜组的手术时间、术后肛门排气时间、留置导尿时间、术后住院时间分别为150.4±30.2min、2.6±0.2d、2.8±0.7d及9.5±2.6d,开腹组分别为168.1±41.3min、3.8±0.7d、4.9±0.6d及15.4±3.7d,腹腔镜组均短于开腹组P<0.05。术中出血量腹腔镜组(92.7±24.1ml)少于开腹组(144.8±23.6ml)(P<0.05)。肿瘤大小、切除标本长度、清扫淋巴结数目及肿瘤远端切缘长度方面与开腹组比较差异无统计学意义(P>0.05)。但是腹腔镜组手术费用、住院总费用要高于开腹组(P<0.05)。腹腔镜组术后切口感染(2.0%)、肠黏连(2.0%)、术后尿潴留(4.0%)明显少于开腹组(P<0.05)。吻合口瘘发生率两者差异无统计学意义(P>0.05)。[结论]腹腔镜TME技术应用于低位、超低位直肠癌保肛手术中疗效确切,具有手术时间短、出血量少、肛门恢复排气时间快、术后并发症发生率低等优点,值得临床推广。
[Objective] To compare the effect of laparoscopic total mesorectal excision (TME) and traditional open rectal cancer radical mastectomy in rectal cancer anal sphincter preservation. [Method] A total of 101 patients with rectal cancer diagnosed in the Second Hospital of Ningbo City from June 2009 to February 2011 were selected and divided into laparoscopic group (49 cases) and open group (52 cases). [Results] The laparoscopic operation time, postoperative anal exhaust time, indwelling catheterization time and postoperative hospital stay were 150.4 ± 30.2min, 2.6 ± 0.2d, 2.8 ± 0.7d and 9.5 ± 2.6d, respectively. Group were 168.1 ± 41.3min, 3.8 ± 0.7d, 4.9 ± 0.6d and 15.4 ± 3.7d, laparoscopic group were shorter than the open group P <0.05. The amount of bleeding in the laparoscopic group (92.7 ± 24.1ml) was less than that in the open group (144.8 ± 23.6ml) (P <0.05). The tumor size, the length of resected specimens, the number of lymph nodes dissected and the length of tumor distal margin were not significantly different from those in open group (P> 0.05). However, laparoscopic surgery costs, the total cost of hospitalization was higher than the open group (P <0.05). Laparoscopic incision infection (2.0%), intestinal adhesion (2.0%), postoperative urinary retention (4.0%) was significantly less than the open group (P <0.05). The incidence of anastomotic fistula was no significant difference between the two (P> 0.05). [Conclusion] The application of laparoscopic TME technique in the anus preservation surgery of low and ultralow rectal cancer is effective. It has the advantages of short operation time, less bleeding, fast recovery of anus and low incidence of postoperative complications. Promotion.