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目的:探讨完全微创手术（TMA）和混合微创/开放手术（HMOA）对直肠癌患者围手术期情况和远期疗效的影响。方法:回顾性分析杭州市第三人民医院2014年1月至2018年8月微创手术治疗的240例直肠癌患者的临床资料。其中，TMA治疗110例（TMA组），HMOA治疗130例（HMOA组）。对患者手术前后的相关指标进行采集和分析。结果:TMA组手术时间明显长于HMOA组[（312.5 ± 20.3）min比（210.8 ± 15.2）min]，住院时间明显短于HMOA组[（4.0 ± 0.5）d比（6.8 ± 1.0）d]，差异有统计学意义（n P0.05）。多因素Cox分析结果显示，体质量指数（BMI）≥ 30 kg/mn 2（n OR= 4.11，95% n CI 1.68~9.72，n P<0.01）、TMA（n OR=0.13，95% n CI 0.06~0.42，n P<0.01）、延迟肠梗阻（n OR=13.6，95% n CI 1.59~110.56，n P<0.05）和再次手术（n OR=15.32，95% n CI 5.52~42.56，n P<0.01）是影响直肠癌患者住院时间延长的独立危险因素。患者随访15~42（29.5 ± 0.2）个月，HMOA组和TMA组3年总生存（OS）率和3年无病生存（DFS）率比较差异无统计学意义（92.5%比92.8%和79.6%比85.5%，n HR=1.20和0.75，95% n CI 0.35~3.14和0.28~1.34，n P=0.98和0.25）。n 结论:行TMA治疗的直肠癌患者较行HMOA治疗的患者具有住院时间短及短期疗效更加突出的优势，但两种微创手术远期疗效相似。“,”Objective:To investigate the effects of total minimally invasive surgery (TMA) and mixed minimally invasive/open surgery (HMOA) on perioperative conditions and long-term efficacy of patients with rectal cancer.Methods:The clinical data of 240 patients with rectal cancer treated with minimally invasive surgery from January 2014 to August 2018 in Hangzhou Third People′s Hospital were retrospectively analyzed. Among them, 110 patients were treated with TMA (TMA group) and 130 patients were treated with HMOA (HMOA group). The relevant indexes of patients before and after surgery were collected and analyzed.Results:The operation time in TMA group was significantly longer than that in HMOA group: (312.5 ± 20.3) min vs. (210.8 ± 15.2) min, the length of hospital stay was significantly shorter than that in HMOA group: (4.0 ± 0.5) d vs. (6.8 ± 1.0) d, and there were statistical differences (n P0.05). Multivariate Cox analysis result showed that BMI ≥ 30 kg/mn 2 (n OR=4.11, 95% n CI 1.68 to 9.72, n P<0.01), TMA (n OR=0.13, 95% n CI 0.06 to 0.42, n P<0.01), delayed bowel obstruction (n OR=13.6, 95% n CI 1.59 to 110.56, n P<0.05) and reoperation (n OR=15.32, 95% n CI 5.52 to 42.56, n P<0.01) were independent risk factors of prolonged hospital stay in patients with rectal cancer. The patients were followed up for 15 to 42 (29.5 ± 0.2) months, and there were no statistical differences in 3-year overall survival (OS) rate and 3-year disease-free survival (DFS) rate between HMOA group and TMA group (92.5% vs. 92.8% and 79.6% vs. 85.5%,n HR=1.20 and 0.75, 95% n CI 0.35 to 3.14 and 0.28 to 1.34, n P=0.98 and 0.25).n Conclusions:Patients with rectal cancer treated with TMA have the advantages of shorter hospital stay and shorter short-term effects compared with those treated with HMOA. However, the long-term effects of the two minimally invasive procedures are similar.