Comparative Analysis on Short-term Efficacy of Laparoscopic versus Open Abdominal Perineal Resection for Rectal Cancer
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摘要: 目的 探讨应用腹腔镜技术施行腹会阴联合切除术治疗直肠癌的可行性、安全性及有效性。方法回顾性分析2010年1月—2011年12月在我院腹部外科胃肠专业组施行腹会阴联合切除术的234例直肠癌患者的临床资料,其中腹腔镜组98例,开腹组136例,分析两组患者手术时间、术中出血量、术后排气时间、术后饮食恢复时间、术后住院时间、淋巴结清扫数目、并发症发生率等各项指标。计量资料采用t检验,计数资料采用χ2检验。结果两组病例在年龄、性别和肿瘤分期、分化程度的构成上差异无统计学意义。腹腔镜组与开腹组手术时间分别为(206.1±58.2)min和(206.2±62.0)min,差异无统计学意义(P=0.991);术中出血量分别为(188.7±151.5)ml和(296.3±274.3)ml,腹腔镜组明显少于开腹组(P=0.014);术后排气时间腹腔镜组为(2.8±1.5)d,开腹组(3.9±2.1)d, 两组比较,差异有统计学意义(P=0.002);饮食恢复时间腹腔镜组为(4.8±1.5)d,开腹组为(5.9±2.1)d,差异有统计学意义(P=0.002);术后住院时间腹腔镜组为(11.1±6.4)d,开腹组为(13.9±7.5)d,差异有统计学意义(P=0.037);两组在瘤体直径、肠段切除长度、肿瘤下缘距肛门距离及淋巴结清扫范围方面比较,差异无统计学意义(P>0.05);术后并发症发生率分别为4.0%和14.7%, 两组比较,差异有统计学意义(P=0.015) 。结论腹腔镜直肠癌腹会阴联合切除术具有创伤小、出血量少、术后恢复快的优点,且不影响手术的彻底性。Abstract: Objective To explore the feasibility,safety and effectiveness of laparoscopy techniques applied in the abdominal perineal resection for rectal cancer. Methods The clinical data of 234 patients with abdominal perineal resection from Jan 2010 to Dec 2011 were analyzed retrospectively,including 98 patients underwent laparoscopic abdominal perineal resection (laparoscopic group),136 cases of open abdominal perineal resection (laparotomy group).The operation time,operative blood loss,time of first passing flatus,time of diet recovery,postoperative hospital stay,number of lymph nodes dissected and complicaton were evaluated using t test or chi-square test. Results Two groups of patients in age,sex and tumor stage,differentiation degree of the composition differences were not statistically significant.The mean operation time was (206.1±58.2)min in laparoscopic group,similar to (206.2±62.0)ml in open group(P=0.991).The mean operative blood loss was (188.7±151.5)ml in laparoscopic group and (296.3±274.3) ml in open group(P=0.014).The bowel movement was restored earlier in laparoscopic group than that in open group,and the diet recovery time and postoperative hospital stay time in the laparoscopic group were shorter than that in the laparotomy group(P<0.05).No significant differences were detected between two groups in tumor size,the distance of tumor from the anal verge,specimen length,or lymph node harvest(P>0.05).The overall complication rates were 4.0% and 14.7%( P=0.015). Conclusion Laparoscopic rectal abdominal perineal resection is less trauma,less bleeding after surgery and quicker recovery,and has no effect on the radical degree of the surgery.
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Key words:
- Rectal cancer /
- Abdominal perineal resection /
- Laparoscopy /
- Laparotomy
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