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目的探讨手辅助腹腔镜与传统开腹手术在直肠癌切除手术中的应用效果,为改善患者预后提供依据。方法选择2008年7月—2011年7月收治的286例直肠癌患者为研究对象,其中186例患者行传统开腹手术治疗(传统开腹组),100例患者行手辅助腹腔镜直肠癌切除手术治疗(腹腔镜组)。比较2组术中创伤(术中失血量、手术切口)及术后恢复情况(术后排气时间、术后住院时间、下床活动时间、术后进食时间等)。随访3~6年,比较2组患者生存率、局部复发率、远期转移率。结果手辅助腹腔镜组的术中失血量、手术切口长度等术中指标及术后止痛时间、术后排气时间、术后住院时间、下床活动时间、术后进食时间等术后指标,均显著优于传统开腹组,差异均具有统计学意义(P<0.05)。腹腔镜组患者的总生存率、局部复发率、远期转移率分别为60.00%、9.00%、27.00%,传统开腹组分别为59.68%、12.90%、32.80%,差异均不具有统计学意义(P>0.05)。结论与传统开腹手术相比,采用手辅助腹腔镜切除手术治疗直肠癌患者,具有创伤轻、出血少、术后恢复快等优点,且能够获得与传统开腹手术相当的预后,安全可行性较高。
Objective To explore the application of hand-assisted laparoscopy and traditional laparotomy in resection of rectal cancer, and to provide evidence for improving the prognosis of patients. Methods A total of 286 patients with rectal cancer admitted to our hospital from July 2008 to July 2011 were enrolled. 186 patients underwent conventional laparotomy (traditional laparotomy) and 100 assisted laparoscopic rectal cancer Surgical treatment (laparoscopic group). Intraoperative trauma (intraoperative blood loss, surgical incision) and postoperative recovery (postoperative exhaust time, postoperative hospital stay, ambulation time, postoperative eating time, etc.) were compared between the two groups. The patients were followed up for 3 to 6 years. The survival rate, local recurrence rate and long-term metastasis rate were compared between the two groups. Results The hand-assisted laparoscopic group intraoperative blood loss, surgical incision length and other intraoperative indicators and postoperative analgesia time, postoperative exhaust time, postoperative hospital stay, ambulation time, postoperative eating time and other indicators, Were significantly better than the traditional open group, the difference was statistically significant (P <0.05). The total survival rate, local recurrence rate and long-term metastasis rate of patients in laparoscopic group were 60.00%, 9.00% and 27.00% respectively, while those in laparoscopic group were 59.68%, 12.90% and 32.80% respectively, with no significant difference (P> 0.05). Conclusion Compared with traditional laparotomy, hand-assisted laparoscopic resection of rectal cancer patients with less trauma, less bleeding, postoperative recovery advantages, and can get the same with the traditional open surgery prognosis, safety and feasibility Higher.