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目的 探讨应用腹腔镜技术行直肠癌根治术的可行性及近期临床疗效。方法 选择2 0 0 3年 2月至 2 0 0 4年 8月我科行腹腔镜直肠癌根治术 2 4例 (Dixon手术 15例、Miles手术 9例 ) ,开腹直肠癌根治术患者 30例 (Dixon手术 2 2例、Miles手术 8例 ) ,对照研究两组病人手术及术后情况。结果 腹腔镜组与开腹组的平均手术时间为 2 0 1.4 6min和 15 6 .33min ,有显著差异 (P <0 .0 1) ,但随着例数的增加腹腔镜手术的时间呈明显下降趋势 ,后 12例病人的平均手术时间为 172 .92min ,与开腹组比较无显著差异 (P >0 .0 5 )。腹腔镜组术中失血量明显少于开腹组 (12 9.17mlvs393.33ml,P <0 .0 1) ,清除的淋巴结数量无显著差异 (11.75枚vs13.2 7枚 ,P >0 .0 5 )。腹腔镜组术后胃肠功能和排尿功能恢复时间明显早于开腹组 (排气、进流食时间 2 .4 6dvs3.6 7d ,P <0 .0 1;进固体饮食时间 3.5 4dvs4 .70d ,P <0 .0 1;留置导尿时间 4 .17dvs5 .97d ,P <0 .0 1)。腹腔镜组住院时间明显短于开腹组(9.5 4dvs12 .97d ,P <0 .0 1) ,住院费用仍明显高于开腹组 (2 .2 7万元vs1.92万元 ,P <0 .0 5 )。结论 应用腹腔镜技术行直肠癌根治术安全可行 ,切除范围能够达到开腹手术的水平 ,且具有创伤小、出血少、术后恢复快等特点 ,极具?
Objective To investigate the feasibility and short-term clinical efficacy of laparoscopic radical mastectomy for rectal cancer. Methods From February 2003 to August 2004, we performed 24 cases of laparoscopic radical resection of rectal cancer (15 cases of Dixon operation and 9 cases of Miles operation), 30 cases of open rectal cancer radical operation (Dixon surgery in 22 cases, Miles surgery in 8 cases), control study of two groups of patients surgery and postoperative conditions. Results The average operation time of laparoscopic group and open group was 20.46min and 15.6.33min, there was a significant difference (P <0.01), but with the increase of the number of laparoscopic surgery was significantly decreased After 12 weeks, the average operation time of the latter 12 patients was 172.92min, which was not significantly different from that of the open group (P> 0.05). Laparoscopic surgery was significantly less blood loss than the open group (12 9.17mlvs393.33ml, P <0.01), the number of clear lymph nodes was no significant difference (11.75 vs13.2 7, P> 0.05 ). Laparoscopy group postoperative gastrointestinal function and urinary function recovery time was significantly earlier than the open group (exhaust, into the feeding time of 2.6 dvs3.6 7d, P <0.01; into the solid diet time of 3.54dvs4. 70d, P <0. 01; indwelling catheterization time 4.17dvs5 .97d, P <0. The hospitalization time in laparoscopic group was significantly shorter than that in open group (9.54dvs12.97d, P <0.01), and the hospitalization cost was still significantly higher than that in laparotomy group (22.7 thousand vs 19200 yuan, P <0 .0 5). Conclusion Laparoscopic surgery is safe and feasible for radical resection of rectal cancer. The resection range can reach the level of open surgery and has the characteristics of less trauma, less bleeding and quick recovery after operation.