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目的:通过与开腹直肠全系膜切除的前瞻性非随机对照研究,评价腹腔镜TME治疗中低位直肠癌的临床疗效。方法:将2001年9月至2005年3月我院外科收治的中低位直肠癌病人,按纳入与剔除标准非随机分为腹腔镜组和开腹组,进行对照分析。结果:入组病例共251例,腹腔镜组和开腹组分别为110例和141例。腹腔镜组的中转开腹率为1.82%。腹腔镜组的平均手术时间、手术切除范围、术后并发症的发生率以及住院天数和开腹组均无显著性差异,而术中出血量、术后肠道功能的恢复要优于开腹组。中位随访期为28(11～57)个月,随访期内两组病例的局部复发率、远处转移率及无瘤生存率均无显著性差异。结论:腹腔镜TME治疗中低位直肠癌是安全、可行的,可以获得和传统开腹手术相同的中长期疗效,且在术后恢复上明显优于传统开腹手术。
OBJECTIVE: To evaluate the clinical efficacy of laparoscopic TME in the treatment of low-grade rectal cancer by prospective, non-randomized controlled open radical resection of total mesorectal cancer. Methods: The low and middle rectal cancer patients admitted to our hospital from September 2001 to March 2005 were randomly divided into laparoscopic group and open group according to inclusion and rejection criteria. Results: There were 251 cases in total and 110 cases in laparoscopic group and 141 cases in laparotomy group. Laparoscopic group laparotomy rate was 1.82%. The average operation time, the scope of resection, the incidence of postoperative complications, hospital stay and laparotomy of laparoscopic group showed no significant difference, but the intraoperative blood loss and postoperative recovery of intestinal function were better than that of laparotomy group. The median follow-up period was 28 (11-57) months. There was no significant difference in the local recurrence rate, distant metastasis rate and tumor-free survival rate between the two groups during the follow-up period. Conclusions: Laparoscopic TME is a safe and feasible method for the treatment of low and middle rectal cancer. It can achieve the same long-term and long-term curative effect as traditional laparotomy and is superior to conventional laparotomy in postoperative recovery.