[1]曹广* 梁杰雄 王晓东.腹腔镜与开腹直肠癌根治术的疗效比较[J].中国微创外科杂志,2016,16(07):581-585.
　Cao Guang,Liang Jiexiong,Wang Xiaodong..A Comparison on Efficacy Between Laparoscopic and Open Radical Resection of Rectal Cancer[J].Chinese Journal of Minimally Invasive Surgery,2016,16(07):581-585.
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腹腔镜与开腹直肠癌根治术的疗效比较()
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《中国微创外科杂志》[ISSN:1009-6604/CN:11-4526/R]

卷:
16
期数:
2016年07期
页码:
581-585
栏目:
临床论著
出版日期:
2016-10-14

文章信息/Info

Title:
A Comparison on Efficacy Between Laparoscopic and Open Radical Resection of Rectal Cancer
作者:
曹广* 梁杰雄 王晓东
（首都医科大学附属北京安贞医院普外科，北京100029）
Author(s):
Cao Guang;  Liang Jiexiong;  Wang Xiaodong.
Department of General Surgery, Beijing Anzhen Hospital of Capital Medical University, Beijing 100029, China
关键词:
腹腔镜手术; 直肠癌; 预后
Keywords:
Laparoscopic surgery; Rectal cancer; Prognosis
文献标志码:
A
摘要:
目的探讨腹腔镜直肠癌根治术治疗不同分期直肠癌的疗效和安全性。方法回顾性分析2009年1月~2013年12月我院96例直肠癌根治术的临床资料，TNM分期0~Ⅰ期42例，其中行腹腔镜手术治疗22例（腹腔镜A组），开腹手术治疗20例（开腹A组）；TNM分期Ⅱ~Ⅲ期54例，其中行腹腔镜手术治疗20例（腹腔镜B组），开腹手术治疗34例（开腹B组），末次随访截止2015年5月，比较不同分期患者2种术式肿瘤学指标、术后并发症、局部复发率、远处转移率及1、3年生存率。结果与开腹A组相比，腹腔镜A组手术时间明显缩短［(121.7±13.5)min vs.(142.4±23.5)min，t=-3530，P=0.000］，出血量明显减少［(80.9±10.6)ml vs.(136.2±32.6)ml，t=-7.559，P=0.000］。与开腹B组相比，腹腔镜B组出血量明显减少［(110.3±15.3)ml vs. (186.5±22.6)ml, t=-12.202，P=0.000］。与开腹A组相比，腹腔镜A组远端切缘距离明显缩短［(2.3±0.6)cm vs.( 3.0±0.7)cm，t=-3.489，P=0.001］。与开腹B组相比，腹腔镜B组淋巴结转移数目明显减少［(2.7±0.4)枚vs.(3.1±0.4)枚，t=-3.298，P=0.002］。腹腔镜B组中转开腹率20%。腹腔镜A组与开腹A组术后局部复发率［9.5%（2/21）vs. 5.0%（1/20）， χ2=0.000，P=1.000］、远处转移率［4.8%（1/21）vs. 5.0%（1/20）， χ2=0.000，P=1.000］、生存率（log-rank χ2=0.102，P=0.750）差异无显著性；腹腔镜B组和开腹B组术后局部复发率［6.2% （1/16）vs. 6.2%（2/32）， χ2=0.000，P=1.000］、远处转移率［6.2%（1/16）vs. 3.1%（1/32），Fisher精确检验，P=1000］、生存率（log-rank χ2=0.158，P=0.691）差异无显著性。结论腹腔镜技术在0~Ⅰ期直肠癌根治术中应用有较好的疗效和安全性，Ⅱ~Ⅲ期直肠癌患者的中转开腹率仍然较高，手术安全性存在风险，应严格做好术前评估。
Abstract:
ObjectiveTo investigate the efficacy and safety of laparoscopic surgery of rectal cancer for different stages of rectal cancer. MethodsA retrospective analysis was made on clinical data of 96 cases of rectal cancer from January 2009 to December 2013. Among 42 cases of TNM staged 0-Ⅰ, there were 22 cases of laparoscopic surgery (laparoscopic group A) and 20 cases of open surgery (laparotomy group A). Among 54 cases of TNM staged Ⅱ-Ⅲ, there were 20 cases of laparoscopic surgery (laparoscopic group B) and 34 cases of open surgery (laparotomy B group). At the end of follow-up ended in May 2015, the tumor markers, postoperative complications, local recurrence, distant metastasis rate and 1-year and 3-year survival rates were compared in different stages of patients between the laparoscopic surgery and open surgery.ResultsAs compared with the laparotomy group A, the laparoscopic group A had shorter surgery time ［(121.7 ± 13.5) min vs. (142.4±23.5) min, t=-3.530, P=0.000］ and less blood loss ［(80.9 ± 10.6) ml vs. (136.3 ± 32.6), t=-7.559, P=0.000］. As compared with the laparotomy group B, the laparoscopic group B had less blood loss ［(110.3±15.3) ml vs. (186.5±22.6) ml, t=-12.202, P= 0.000］. As compared with the laparotomy group A, the laparoscopic group A had significantly reduced distal resection margin distance ［(2.3±0.6) cm vs. (3.0±0.7) cm, t=-3.489, P=0.001］. As compared with the laparotomy group B, the number of lymph node metastasis was significantly reduced in the laparoscopic group B (2.7±0.4 vs. 3.1±0.4, t=-3.298, P=0002). The conversion rate to laparotomy in the laparoscopic group B was 20%. There were no significant difference between the laparoscopic group A and laparotomy group A in local recurrence rate ［9.5% (2/21) vs. 5.0% (1/20), χ2=0.000, P=1.000］, distant metastasis rate ［4.8% (1/21) vs. 5.0% (1/20), χ2=0.000, P=1.000］, and survival rate (log-rank χ2=0.102, P=0750). There were no significant difference between the laparoscopic group B and laparotomy group B in local recurrence rate ［6.2% (1/16) vs. 6.2% (2/32), χ2=0.000, P=1.000］, distant metastasis rate ［6.2% (1/16) vs. 3.1% (1/32), Fisher test, P=1000］, and survival rate (log-rank χ2=0.158, P=0.691).ConclusionsLaparoscopic radical surgery for TNM stage 0-Ⅰ of rectal cancer has a good effect and safety. The conversion rate to laparotomy in TNM staged Ⅱ-Ⅲ rectal cancer patients is still high with relatively high surgical risks, which requires strict preoperative assessment.

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备注/Memo

备注/Memo:
*通讯作者，E-mail：cguang2@163.com
更新日期/Last Update: 2016-10-14