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目的探讨腹腔镜辅助全直肠系膜切除术治疗直肠癌的安全性、可行性和疗效。方法回顾分析2008年10月至2010年10月间136例行手术治疗的直肠癌患者临床资料,其中腹腔镜辅助全直肠系膜切除71例(腔镜组),开腹全直肠系膜切除术65例(开腹组);比较2组的手术时间、手术出血量、术后肠道功能恢复、疼痛、术后住院时间、手术并发症、淋巴结清扫数量及疗效。结果 2组患者均顺利完成手术,腔镜组无中转开腹。2组手术时间、手术出血量、淋巴结清扫数量和手术并发症发生率差异无统计学意义(P>0.05);腔镜组术后肠道功能恢复、术后住院时间和术后疼痛均优于开腹组(P<0.05);术后2年生存率差异无统计学意义(P>0.05)。结论腹腔镜辅助全直肠系膜切除术治疗直肠癌安全可行,且微创,2年生存率亦无差别,但远期疗效需进一步观察。
Objective To investigate the safety, feasibility and efficacy of laparoscopic assisted total mesorectal excision in the treatment of rectal cancer. Methods The clinical data of 136 patients with rectal cancer underwent surgery from October 2008 to October 2010 were retrospectively analyzed. Among them, 71 patients underwent laparoscopic assisted total mesorectal excision (endoscopic group), 65 underwent open total mesorectal excision (Open group). The operation time, operative bleeding volume, postoperative intestinal function recovery, pain, postoperative hospital stay, operative complications, lymph node dissection and curative effect were compared between the two groups. Results The patients in both groups were successfully performed the operation, laparoscopic group without laparotomy. There was no significant difference in operative time, amount of surgical bleeding, number of lymph node dissection and incidence of surgical complications between the two groups (P> 0.05). The postoperative intestinal function recovery, postoperative hospital stay and postoperative pain were better in the endoscopic group (P <0.05). There was no significant difference in 2-year survival rate after operation (P> 0.05). Conclusions Laparoscopic assisted total mesorectal excision for the treatment of rectal cancer is safe and feasible. The minimally invasive and 2-year survival rates are no different, but the long-term efficacy needs further observation.