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目的 :前瞻性评估腹腔镜辅助腹会阴切除和开腹手术这两种技术的优劣性 ,并探讨腹腔镜辅助腹会阴切除的可行性和安全性。方法 :将根治切除的 4 1例直肠癌患者 ,分为腹腔镜组 2 1例和开腹组 2 0例 ,观察两组肿瘤手术切除、并发症、术后恢复和肿瘤复发情况。结果 :两组的手术时间、出血量差异无统计意义 (t=0 .6 0 6 ,P =0 .5 4 8和 t=0 .0 77,P =0 .939)。切除标本的长度、全直肠系膜完整数、肠系膜下动脉高位结扎数、淋巴结切除数等肿瘤学根治方面差异亦无统计学意义 (均 P>0 .0 5 )。腹腔镜组止痛药使用少于开腹组 (χ2 =4 .0 84 ,P =0 .0 4 3) ,腹腔镜组的造口排气时间、起床活动时间均短于开腹组 (t=2 .4 5 5 ,P =0 .0 1 9和 t=2 .6 37,P =0 .0 1 2 ) ,住院时间两组无统计学差异 (t=0 .6 81 ,P =0 .5 0 0 )。两组的并发症发生率大致相同 (均 P >0 .0 5 )。两组随访时间分别为 2 4个月 (6～ 5 8个月 )和 36个月 (7～ 6 6个月 ) (P =0 .1 6 3) ,两组肿瘤早期复发率类似 (P =1 .0 0 0 )。结论 :提示腹腔镜腹会阴切除在技术上不仅是可行的 ,也是安全的
PURPOSE: To prospectively evaluate the advantages and disadvantages of laparoscopic assisted perineal resection and laparotomy, and to explore the feasibility and safety of laparoscopic assisted abdominal perineal excision. Methods: Forty-one patients with rectal cancer who underwent radical resection were divided into 21 cases of laparoscopic group and 20 cases of open group. Surgical resection, complications, postoperative recovery and tumor recurrence were observed in both groups. Results: There was no significant difference in operative time and bleeding between the two groups (t = 0.606, P = 0.488 and t = 0.777, P = 0.399). The length of resected specimens, the total number of mesorectal mesenteric, the number of high ligation of the inferior mesenteric artery, the number of lymph node resection and other oncological radical differences were not statistically significant (P> 0.05). Laparoscopic group painkillers use less than the open group (χ2 = 4.004, P = 0.043), laparoscopic stoma exhaust time, time to get up activities were shorter than the open group (t = There was no significant difference in hospitalization time between the two groups (t = 0.661, P = 0.45, P = 0.0001 and t = 2.36, P = 0.122). 5 0 0). Complications rates were similar in both groups (P> 0.05). The two groups were followed up for 24 months (6 ~ 58 months) and 36 months (7 ~ 6 6 months) (P = 0.1363) 1 .0 0 0). Conclusion: Laparoscopic abdominal perineal resection is not only technically feasible but also safe