腹腔镜直肠癌根治术与开腹手术临床安全性的对比
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摘要
目的探讨腹腔镜直肠癌根治术与开腹手术的安全性及临床疗效。方法筛选取2010年1月至2012年12月经结肠镜检查且术前病理诊断明确为直肠癌的患者。腹腔镜手术组为接受腹腔镜直肠癌根治术的患者36例;开腹手术组为接受开腹直肠癌根治术患者35例。比较2组患者术中情况、术后恢复以及术后并发症发生情况。结果腹腔镜手术组术中失血量、术后胃肠道恢复时间、下床活动时间等明显低于开腹组,切口感染与肺部感染的发生率也显著低开腹手术组,上述差异有统计学意义(P<0.05)。而2组患者在手术时间、切除范围、淋巴结清扫数目以及术后吻合口相关并发症等方面未表现出显著差异(P>0.05)。结论腹腔镜手术是直肠癌根治术的安全手术方法,并且具有创伤小、术后恢复快及并发症少等优点。
Objective To evaluate the safety and feasibility of laparoscopic radical resection for colorectal cancer in comparison with open procedure. Me thods From Jan. 2010 to Dec. 2012, 71 patients with colorectal cancer were divided into two groups, and 36 cases in the laparoscopic operation group, while 35 cases in the open operation group. The clinic pathological data and short-term outcome were collected and compared. Re s ults The perative blood loss, gastrointesinal function recovery time, ambulation time, pulmonary infection and incision infection in the laparoscopic group were significantly lower than those in the open group(P<0.05). However,there were no significant differences between the two groups in terms of operation time, resection range, number of lymph node dissection and postoperative complications related to anastomosis(P >0.05). Conclus ions The laparoscopic radical resection for colorectal cancer is a safe and feasible technique for lower rectal cancer, and provides better short-term outcome compared with the traditional open procedure.
Objective To evaluate the safety and feasibility of laparoscopic radical resection for colorectal cancer in comparison with open procedure. Me thods From Jan. 2010 to Dec. 2012, 71 patients with colorectal cancer were divided into two groups, and 36 cases in the laparoscopic operation group, while 35 cases in the open operation group. The clinic pathological data and short-term outcome were collected and compared. Re s ults The perative blood loss, gastrointesinal function recovery time, ambulation time, pulmonary infection and incision infection in the laparoscopic group were significantly lower than those in the open group(P<0.05). However,there were no significant differences between the two groups in terms of operation time, resection range, number of lymph node dissection and postoperative complications related to anastomosis(P >0.05). Conclus ions The laparoscopic radical resection for colorectal cancer is a safe and feasible technique for lower rectal cancer, and provides better short-term outcome compared with the traditional open procedure.
引文
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[20] DUCHALAIS E,MACHAIRAS N,KELLEY S R,et al.Does prolonged operative time impact postoperative morbidity in patients undergoing robotic-assisted rectal resection for cancer[J].SurgEndosc,2018,32(8):3659-3666.
[2]李道娟,李倩,贺宇彤.结直肠癌流行病学趋势[J].肿瘤防治研究,2015,42(3):305-310.
[3] TSAI J T,KIU K T,HUANG M T,et al. The learning curve for laparoscopic colectomy in colorectal cancer at a new regional hospital[J].Asian J Surg,2016,39(1):34-40.
[4] KOROLIJA D,TADIC S,SIMIC D. Extent of oncological resection in laparoscopic vs. open colorectal surgery:meta-analysis[J].Langenbecks Arch Surg,2003,387(9-10):366-371.
[5] BESSA X,CASTELLS A,LACY A M,et al. Laparoscopic-assisted vs. open colectomy for colorectal cancer:influence on neoplastic cell mobilization[J].J Gastrointest Surg,2001,5(1):66-73.
[6] HASEGAWA H,KABESHIMA Y,WATANABE M,et al.Randomized controlled trial of laparoscopic versus open colectomy for advanced colorectal cancer[J].Surg Endosc,2003,17(4):636-640.
[7] CHOI S B,PARK H K,HONG J H,et al. Postoperative respiratory complications and peak airway pressure during laparoscopic colectomy in patients with colorectal cancer[J].Surg Laparosc Endosc Percutan Tech,2015,25(1):83-88.
[8] KIMI,KIMB,KIMY. Impact of prior abdominal surgery on rates of conversion to open surgery and short-term outcomes after laparoscopic surgery for colorectal cance[J].PLo S One,2015,10(7):e0134058.
[9]陈士平,纪祥栋,汪海生.腹腔镜结直肠癌根治术对结直肠癌患者临床疗效及胃肠功能的影响[J].临床医药文献电子杂志,2018,5(A2):90+101.
[10] CHEN T,FANG J,WANG Z,et al. Laparoscopic surgery decreases the surgical risks associated with hyperlipidemia in rectal cancer:a retrospective analysis of 495 patients[J].Surg Laparosc EndoscPercutan Tech,2014,24(5):e162-166.
[11]杨增辉,鲍传庆,许炳华,等.末端回肠悬吊术在腹腔镜下低位直肠癌根治术中的应用[J].实用医学杂志,2018,34(24):4102-4105.
[12]胡英斌,白飞,张剑.腹腔镜和开腹手术在男性低位直肠癌中盆腔自主神经功能保留的临床对比研究[J].中国现代手术学杂志,2016,20(1):1-4.
[13] CAGINO K,ALTIERI M S,YANG J,elt. Effect of academic status on outcomes of surgery for rectal cancer[J].Surg Endosc,2018,32(6):2774-2780.
[14]谯瞧,车向明,樊林.直肠癌腹腔镜全直肠系膜切除术对排尿功能的影响研究[J].中国普通外科杂志,2015,24(10):1427-1432.
[15]李杰,李禹呈,郑阳春,等.腹腔镜下结直肠癌体内切除标本经直肠拖出手术(NOSES)的无菌和无瘤操作技巧[J].中华腔镜外科杂志(电子版),2018,11(06):360-363.
[16]DING Z,WANG Z,HUANG S,elt. Comparison of laparoscopic vs. open surgery for rectal cancer[J].Mol Clin Oncol,2017,6(2):170-176.
[17] ACKERMAN S J,DANIEL S,BAIK R,et al.Comparison of complication and conversion rates between robotic-assisted and laparoscopic rectal resection for rectal cancer:which patients and providers could benefit most from robotic-assisted surgery[J].J Med Econ,2018,21(3):254-261.
[18] TRASTULLIS1,CIROCCHI R,LISTORTI C,et al. Laparoscopic vs open resection for rectal cancer:a meta-analysis of randomized clinical trials[J].Colorectal Dis,2012,14(6):e277-296.
[19]CHEUNG H Y C,DENT,RICHARDSON G L,elt. Pathological outcomes in rectal cancer following laparoscopic surgery[J].Asia Pac J ClinOncol,2018,14(2):e175-e180.
[20] DUCHALAIS E,MACHAIRAS N,KELLEY S R,et al.Does prolonged operative time impact postoperative morbidity in patients undergoing robotic-assisted rectal resection for cancer[J].SurgEndosc,2018,32(8):3659-3666.