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目的探讨腹腔镜结直肠癌切除术的临床疗效和微创优势。方法采用与同期开腹手术相比较的方法,将2001年10月—2008年11月行结直肠癌切除的患者分为腹腔镜手术组(80例)和开腹手术组(82例),比较二组标本的病理结果,围术期情况,评价各组的肿瘤根治性,手术安全性、术后恢复情况、医疗费用和近期随访结果。结果腹腔镜手术组术中出血量明显减少(P<0.05),术后应用吗啡镇痛的剂量明显减少(P<0.01),术后离床时间和术后住院日数明显减少(P<0.05)。肿瘤根治性相关临床病理学结果提示二组患者完全可以达到相同的根治程度,二组术后并发症比较差异无统计学意义(P>0.05)。腹腔镜组未发现Trocar穿刺部位及小切口部位肿瘤种植转移,二组在局部复发、远处转移、腹盆腔广泛转移和病死率差异无统计学意义(P>0.05)。腹腔镜手术组费用显著高于开腹手术组(P<0.05)。结论腹腔镜结直肠癌切除术近期疗效,微创等方面较开腹手术有较明显的优势,具有可行性。
Objective To investigate the clinical efficacy and minimally invasive advantages of laparoscopic colorectal cancer resection. Methods Compared with open laparotomy in the same period, patients who underwent colorectal cancer resection from October 2001 to November 2008 were divided into laparoscopic surgery group (80 cases) and open surgery group (82 cases). Pathological results of two groups of specimens, perioperative situation, evaluation of each group of tumor radical, surgical safety, postoperative recovery, medical costs and the results of the recent follow-up. Results The amount of bleeding during operation in laparoscopic surgery group was significantly decreased (P <0.05), and the dose of morphine analgesia after operation was significantly decreased (P <0.01). The time of leaving bed and the number of hospital stay after operation were significantly decreased (P <0.05) . The clinicopathological findings of radical tumor suggest that the two groups of patients can achieve the same degree of radical cure, the postoperative complications in the two groups showed no significant difference (P> 0.05). There was no significant difference between the two groups in local recurrence, distant metastasis, extensive abdominal pelvic metastasis and case fatality rate (P> 0.05). The cost of laparoscopic surgery group was significantly higher than that of open surgery group (P <0.05). Conclusion Laparoscopic resection of colorectal cancer in the short term efficacy, minimally invasive and other aspects of open surgery has obvious advantages, is feasible.