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目的:探讨腹腔镜下全直肠系膜切除术(total mesorectal excision,TME)与开腹手术相比较,在疗效上的优势。方法 :回顾性分析黄山市人民医院2006年1月—2014年8月收治符合研究设定纳入标准的100例直肠癌手术患者,比较腹腔镜与开腹手术在手术持续时间、术中出血量、术后肛门排气时间、术后住院天数、保肛率以及术后并发症等方面的差异。结果:腹腔镜组手术持续时间(170.5±29.9)min相对于传统开腹手术组(151.9±23.6)min较长(t=3.458,P=0.001);术中出血量(81.5±27.0)m L较传统开腹手术组(101.4±23.7)m L少(t=3.917,P<0.001);术后肛门排气时间(47.0±12.6)h比开腹手术(55.4±14.7)h短(t=3.084,P=0.003);术后住院天数(11.0±4.6)d比开腹手术组(13.4±4.1)d短(t=2.734,P=0.007);腹腔镜手术组在保肛率方面(74%,34/50)与传统开腹手术(64%,32/50)相比较无明显统计学差异(χ2=1.169,P=0.280);术后腹腔镜手术组患者未发生吻合口瘘、肺部感染以及切口感染,开腹手术组患者术后出现吻合口瘘4例、肺部感染3例、切口感染3例,但组间差异无统计学意义(P>0.05)。结论:相对于开腹手术,腹腔镜下TME具有一定优势。
Objective: To investigate the efficacy of laparoscopic total mesorectal excision (TME) compared with laparotomy. Methods: A retrospective analysis of 100 cases of rectal cancer patients who met the criteria set by the study from January 2006 to August 2014 in Huangshan People’s Hospital was performed. Laparoscopy and laparotomy were compared in terms of operation duration, intraoperative blood loss, Postoperative anal exhaust time, postoperative hospital stay, anal sphincter rate and postoperative complications. Results: The duration of laparoscopic surgery (170.5 ± 29.9) min was longer (151.9 ± 23.6) min (t = 3.458, P = 0.001) and the mean amount of bleeding was (81.5 ± 27.0) m L Compared with the laparotomy group (101.4 ± 23.7) m L (t = 3.917, P <0.001), the time of postoperative anal exhaust (47.0 ± 12.6) h was shorter than that of laparotomy (55.4 ± 14.7) h 3.084, P = 0.003). The length of postoperative hospital stay (11.0 ± 4.6) days was shorter than that of the open surgery group (13.4 ± 4.1 days) (t = 2.734, P = 0.007) %, 34/50) had no significant difference with traditional laparotomy (64%, 32/50) (χ2 = 1.169, P = 0.280). No anastomotic fistula, 4 cases of anastomotic fistula, 3 cases of lung infection and 3 cases of incision infection after operation in open surgery group, but there was no significant difference between the two groups (P> 0.05). Conclusion: Laparoscopic TME has some advantages over open surgery.