CAJ | 학술논문

目的比较腹腔镜与开腹直肠癌根治术的远期和近期临床疗效.方法 2004年6月至2009年8月由同一手术组完成腹腔镜直肠癌根治术312例及开腹直肠癌根治术226例,分析比较两组患者的远期生存率、手术情况、术后恢复情况及术后并发症.采用Life table分析法对资料进行生存分析,Gehan法对生存曲线进行显著性检验.结果两组患者在年龄、性别、肿瘤分期和肿瘤病理分型等方面无明显差异.术后3、5年生存率腹腔镜组分别是84.5％和66.7％；开腹组分别是83.3％和64.8％,两组患者术后生存率经Life table生存分析无明显差异.腹腔镜组和开腹组的出血量分别为61 ±13ml和174±84 ml(t =23.24,P＜0.05)、术后排气时间分别为2.7±1.3d和3.6±1.8 d(t =6.61,P＜0.05)、术后住院日分别为9.1±2.4d和12.0±3.4 d(t =11.8,P＜0.05).腹腔镜组与开腹组淋巴结清扫数分别为11.0±2.7枚和12.0±3.6枚(t=1.72,P＞0.05),直肠标本长度分别为16.0±3.4cm和16.0±4.3 cm(t =0,P＞0.05),直肠肿瘤远端切缘分别为3.2±1.3cm和3.2±1.7 cm(t =0,P＞0.05),开腹组术后切口感染28例,腹腔镜组8例(P＜0.05),两组患者术后其他并发症发生率无统计学差异.结论腹腔镜直肠癌根治术远期疗效与开腹手术相似,且具有创伤小、术后恢复快、并发症少等优势.
목적 비교복강경여개복직장암근치술적원기화근기림상료효.방법 2004년6월지2009년8월유동일수술조완성복강경직장암근치술312례급개복직장암근치술226례,분석비교량조환자적원기생존솔、수술정황、술후회복정황급술후병발증.채용Life table분석법대자료진행생존분석,Gehan법대생존곡선진행현저성검험.결과 량조환자재년령、성별、종류분기화종류병리분형등방면무명현차이.술후3、5년생존솔복강경조분별시84.5％화66.7％；개복조분별시83.3％화64.8％,량조환자술후생존솔경Life table생존분석무명현차이.복강경조화개복조적출혈량분별위61 ±13ml화174±84 ml(t =23.24,P＜0.05)、술후배기시간분별위2.7±1.3d화3.6±1.8 d(t =6.61,P＜0.05)、술후주원일분별위9.1±2.4d화12.0±3.4 d(t =11.8,P＜0.05).복강경조여개복조림파결청소수분별위11.0±2.7매화12.0±3.6매(t=1.72,P＞0.05),직장표본장도분별위16.0±3.4cm화16.0±4.3 cm(t =0,P＞0.05),직장종류원단절연분별위3.2±1.3cm화3.2±1.7 cm(t =0,P＞0.05),개복조술후절구감염28례,복강경조8례(P＜0.05),량조환자술후기타병발증발생솔무통계학차이.결론 복강경직장암근치술원기료효여개복수술상사,차구유창상소、술후회복쾌、병발증소등우세.
Objective To compare the results of laparoscopic and open radical operation for rectal cancer.Methods Three hundred and twelve patients with laparoscopic operation and 226 cases with open operation during the period of June 2004 to August 2009 were included.The long-term survival,operative data,postoperative recovery and complications were compared between the two grougs.Results There were no significant differences in age,sex,tumor stage and histologic types between the two groups.The 3 and 5- year-survival rate was 84.5％ and 66.7％ in laparoscopic group,83.3％ and 64.8％ in traditional operation group with no significant difference by Life-table method.The intraoperative blood loss in laparoscopic group was obviously less than that in open group (61 ± 13 nl vs 174 ±84 ml,t =23.24,P ＜0.05).The time of p assage of gas by anus and hospital stay in laparoscopic group were significantly shorter than those in openg roup (2.7 ±1.3 d vs 3.6 ±1.8 d,t =6.61,P ＜0.05;9.1 ±2.4 d vs 12.0 ±3.4 d,t =11.8,P ＜0.05).No significant difference was observed between the two groups in the lymph nodes clearance ( 11.0 ± 2.7 vs 12±3.6,t=1.72,P ＞0.05),specimen length (16.0 ±3.4 cm vs 16.0 ±4.3 cm,t =0,P＞0.05) and distal margin (3.2 ± 1.3 cm vs 3.2 ± 1.7 cm,t =0,P ＞0.05).Surgical site infection of incision developed in 28 cases in open surgery group and in 8 cases in laparoscopic group (P ＜ 0.05 ).Conclusions Laparoscopic surgery for rectal cancer can achieve similar long-term survival as conventional laparotomy with minimal invasion,quicker recovery and less complications.