论文部分内容阅读
目的比较直肠癌经腹腔镜辅助和传统开腹全直肠系膜切除术(total mesorectal excision,TME)治疗直肠癌的可行性和短期临床疗效。方法 2005年8月至2009年4月期间同期收治了74例直肠癌患者,由患者自由选择上述手术方式,分为腹腔镜组(31例)和传统开腹组(43例),对其临床资料进行回顾性分析。比较两组病例手术时间,手术出血量,清扫的淋巴结数目,手术标本的长度,直肠远切端距肿瘤下缘的距离,术后肠道功能恢复时间,术后住院时间,术中和术后并发症。结果两组病例的一般情况和Dukes分期差异无统计学意义。两组均无手术死亡病例。腹腔镜组和开腹组手术时间分别为(181.61±45.65)min和(136.28±31.07)min,术中平均出血量分别为(141.61±54.52)mL和(234.42±73.72)mL,术后肠道功能恢复时间分别为(34.03±7.74)h和(79.28±10.43)h,术后住院时间分别为(11.81±3.04)d和(14.26±4.78)d,两组比较差异均有统计学意义(P<0.05)。清扫的淋巴结数目分别为(10.64±3.03)个和(11.44±3.43)个,直肠远切端距肿瘤下缘的距离分别是(3.59±0.67)cm和(3.53±0.79)cm,切除标本的长度分别是(22.01±3.42)cm和(23.58±3.67)cm,两组病例以上参数差异均无统计学意义(P>0.05)。腹腔镜组术中和术后并发症发生率为6.5%(2/31)和12.9%(4/31),开腹组分别为4.7%(2/43)和16.3%(7/43),两组比较差异无统计学意义(P>0.05)。结论腹腔镜辅助下全直肠系膜切除术治疗直肠癌是安全、可行的,可完全获得与传统开腹手术相似或更优的短期疗效。
Objective To compare the feasibility and short-term clinical efficacy of laparoscopic-assisted and traditional open mesorectal excision (TME) for rectal cancer. Methods From August 2005 to April 2009, 74 patients with rectal cancer were enrolled in the same period. Patients were divided into laparoscopic group (31 cases) and traditional laparotomy group (43 cases) Data for retrospective analysis. The operation time, the amount of bleeding, the number of lymph nodes dissected, the length of the surgical specimens, the distance from the distal edge of the distal rectum to the tumor, the postoperative recovery time of intestinal function, postoperative hospital stay, intraoperative and postoperative complications were compared between the two groups disease. Results There was no significant difference between the two groups in general and Dukes stage. There were no surgical deaths in both groups. The operative time of laparoscopic group and open group were (181.61 ± 45.65) min and (136.28 ± 31.07) min, respectively. The mean intraoperative blood loss were (141.61 ± 54.52) mL and (234.42 ± 73.72) mL respectively. The functional recovery time was (34.03 ± 7.74) h and (79.28 ± 10.43) h, respectively. The postoperative hospital stay was (11.81 ± 3.04) d and (14.26 ± 4.78) days respectively, with significant difference between the two groups <0.05). The number of dissected lymph nodes were (10.64 ± 3.03) and (11.44 ± 3.43), respectively. The distance from the distal edge of the distal rectum to the tumor was (3.59 ± 0.67) cm and (3.53 ± 0.79) cm, respectively (22.01 ± 3.42) cm and (23.58 ± 3.67) cm respectively. There was no significant difference in the above parameters between the two groups (P> 0.05). The incidence of intraoperative and postoperative complications in laparoscopic group was 6.5% (2/31) and 12.9% (4/31) in open laparoscopic group and 4.7% (2/43) and 16.3% (7/43) in laparotomy group, respectively There was no significant difference between the two groups (P> 0.05). Conclusions Laparoscopic-assisted total mesorectal excision for rectal cancer is safe and feasible, and can achieve short-term effects similar to or better than traditional laparotomy.