CAJ | 학술논문

目的：比较手辅助腹腔镜手术(hand-assisted laparoscopic surgery, HALS)和传统开腹手术对直肠癌保肛手术的根治性和近期临床效果。方法2008年1月至2010年12月中山大学附属第一医院胃肠外科病理学确诊的112例直肠腺癌患者，分别用HALS和传统开腹手术完成直肠癌保肛手术。其中HALS组49例，传统开腹手术组63例，比较两组临床资料的性别、年龄、肿瘤部位、肠管浸润环周度、大体类型、肿瘤最大直径和腹部手术史有无统计学差异。再比较2组的手术时间，术中输血量，根治手术切除范围，术式种类，淋巴结取材和阳性淋巴结个数，环周切缘，全直肠系膜切除的评估，临床病理学分期以及术后并发症的发生率，切口长度和术后胃肠功能和排尿功能恢复和术后住院时间。结果两组临床资料的性别、年龄、肿瘤部位、肠管浸润环周度、大体类型、肿瘤最大直径和腹部手术史有无统计学差异(P＞0.05)。比较HALS组与传统开腹手术组术后各项参数：手术时间，输血例数，保肛术式选择，根治性切除范围，根治率，术后病理学检查淋巴结个数和阳性淋巴结个数，分化程度和病理学分期等无统计学差异（P＞0.05），术后并发症发生率和住院时间以及拔除导尿管时间也没有统计学差异(P＞0.05)。HALS组腹部切口长度短(P=0.001)，术后肠道功能恢复(P=0.001)，有统计学意义。结论选择HALS进行直肠癌保肛手术不影响根治性，切口长度短，肠管功能恢复快，是可选择的外科技术，近期疗效和传统开腹手术没有统计学差异。
목적：비교수보조복강경수술(hand-assisted laparoscopic surgery, HALS)화전통개복수술대직장암보항수술적근치성화근기림상효과。방법2008년1월지2010년12월중산대학부속제일의원위장외과병이학학진적112례직장선암환자，분별용HALS화전통개복수술완성직장암보항수술。기중HALS조49례，전통개복수술조63례，비교량조림상자료적성별、년령、종류부위、장관침윤배주도、대체류형、종류최대직경화복부수술사유무통계학차이。재비교2조적수술시간，술중수혈량，근치수술절제범위，술식충류，림파결취재화양성림파결개수，배주절연，전직장계막절제적평고，림상병이학분기이급술후병발증적발생솔，절구장도화술후위장공능화배뇨공능회복화술후주원시간。결과량조림상자료적성별、년령、종류부위、장관침윤배주도、대체류형、종류최대직경화복부수술사유무통계학차이(P＞0.05)。비교HALS조여전통개복수술조술후각항삼수：수술시간，수혈례수，보항술식선택，근치성절제범위，근치솔，술후병이학검사림파결개수화양성림파결개수，분화정도화병이학분기등무통계학차이（P＞0.05），술후병발증발생솔화주원시간이급발제도뇨관시간야몰유통계학차이(P＞0.05)。HALS조복부절구장도단(P=0.001)，술후장도공능회복(P=0.001)，유통계학의의。결론선택HALS진행직장암보항수술불영향근치성，절구장도단，장관공능회복쾌，시가선택적외과기술，근기료효화전통개복수술몰유통계학차이。
Objective To compares the differences of the effectiveness of radical sphincter-preserved surgery and near-survival rate between hand-assisted laparoscopic surgery (HALS) and open surgery.Methods From January 2008 to December 2010, 112 patients with low or ultra-low rectal cancer underwent sphincter-preserved radical resection by means of HALS and open surgery. 49 cases are enrolled in HALS group and 63 are in open group.The sexuality, age, tumor site, gross specimen, max diameter of tumor and abdominal surgical history of the patients between the two groups were compared in this study. And we also compared the operative time, blood loss, the dissection range, surgical method, the number of harvested lymph node and the number of positive lymph node, circumferential cutting margin assessment, the specimen visual assessment of total mesorectal excision(TME), the length of incision, postoperative pathology staging,the incidence of postoperative complications, the recovery of bowel function and urination and postoperative hospital staying time. Result There are no statistic differences in sexuality, age, tumor site, gross specimen, max diameter of tumor and abdominal surgical history between the two groups(P>0.05). The results of comparison between HALS group and open group indicated that there is no difference in surgical time, blood loss, the dissection range, surgical method, the number of harvested lymph node and the number of positive lymph node, circumferential cutting margin assessment, the specimen visual assessment of TME, the length of incision, postoperative pathology staging,the incidence of postoperative complications and postoperative hospital staying time in this study(P>0.05). The recovering time of bowel function and urination in HALS group is shorter(P<0.001). Conclusion Rectal cancer can be safely resected using HALS techniques with a short incision and a short bowel function recovery time. There is no difference in near effectiveness between HALS and open surgery.