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目的探讨低位直肠癌采用腹腔镜全直肠系膜切除(TME)联合内括约肌切除术治疗的临床应用效果。方法 选取肛肠科2009年5月至2011年3月收治的低位直肠癌患者84例,采用随机数字表法分为开腹组和腹腔镜组,每组各42例;分别采用开腹TME联合内括约肌切除术及腹腔镜TME联合内括约肌切除术治疗;比较2组患者手术时间、术中淋巴结清扫数量、术中出血量、术后排气时间、住院时间及术后并发症发生情况。结果腹腔镜组患者术中出血量、术后排气时间及住院时间较开腹组明显减少(P均<0.05),但2组患者手术时间及淋巴结清除数比较无统计学差异(P均>0.05)。腹腔镜组患者术后并发症发生率较开腹组明显降低(9.5%vs31.0%,P<0.05)。结论低位直肠癌腹腔镜TME联合内括约肌切除术治疗效果确切,能够减少术中创伤,缩短病程,且并发症发生风险显著降低。
Objective To investigate the clinical effect of laparoscopic total mesorectal excision (TME) combined with internal sphincter resection for low rectal cancer. Methods Eighty-four patients with low rectal cancer admitted to our department from May 2009 to March 2011 were randomly divided into open group and laparoscopic group, 42 cases in each group. Sphincterotomy and laparoscopic TME combined with internal sphincterotomy. The operation time, number of lymph node dissection, blood loss during operation, postoperative exhaust time, hospital stay and postoperative complications were compared between the two groups. Results The intraoperative blood loss, postoperative exhaust time and hospital stay in laparoscopic group were significantly lower than those in laparotomy group (all P <0.05), but there was no significant difference in operative time and lymph node clearance among two groups (P> 0.05). The incidence of postoperative complications in laparoscopic group was significantly lower than that in open group (9.5% vs 31.0%, P <0.05). Conclusions Laparoscopic TME combined with internal sphincterotomy for low rectal cancer is effective and can reduce the intraoperative trauma and shorten the course of the disease, and the risk of complications is significantly reduced.