CAJ | 학술논문

目的：比较手辅助腹腔镜和腹腔镜及开腹手术3种方式应用于直肠癌根治术的近期疗效。方法回顾性分析2009年6月至2012年6月在浙江省肿瘤医院结直肠外科接受直肠癌根治术的390例患者的临床资料，其中手辅助腹腔镜组101例，腹腔镜组157例，开腹手术组132例。比较3组患者在手术时间、术中出血量、切口长度、中转开腹率、淋巴结检出数目、标本长度、下切缘长度、术后恢复排气时间、进食时间、术后住院时间及并发症等方面的差异。结果腹腔镜组手术时间为（231±61） min，明显长于手辅助腹腔镜组的（173±39） min和开腹手术组的（163±38） min （P＜0．01）。手辅助腹腔镜组与腹腔镜组的中转开腹率分别为2．0％（2/101）和3．2％（5/157），差异无统计学意义（P＝0．708）。手辅助腹腔镜组、腹腔镜组和开腹手术组的术后并发症发生率分别为11．9％（12/101）、11．5％（18/157）和19．7％（26/132），差异无统计学意义（P＝0．100）。3组术后标本长度、下切缘长度、清扫淋巴结数目和阳性淋巴结数目的差异无统计学意义（均P＞0．05）。手辅助腹腔镜组与腹腔镜组患者的术后排气时间、进食时间和住院时间均明显短于开腹手术组（均P＜0．01）。结论手辅助腹腔镜手术与腹腔镜手术一样具有创伤小和术后恢复快等优势，可达到与开腹手术一样的近期肿瘤根治效果，但手辅助腹腔镜手术明显缩短了手术时间。
목적：비교수보조복강경화복강경급개복수술3충방식응용우직장암근치술적근기료효。방법회고성분석2009년6월지2012년6월재절강성종류의원결직장외과접수직장암근치술적390례환자적림상자료，기중수보조복강경조101례，복강경조157례，개복수술조132례。비교3조환자재수술시간、술중출혈량、절구장도、중전개복솔、림파결검출수목、표본장도、하절연장도、술후회복배기시간、진식시간、술후주원시간급병발증등방면적차이。결과복강경조수술시간위（231±61） min，명현장우수보조복강경조적（173±39） min화개복수술조적（163±38） min （P＜0．01）。수보조복강경조여복강경조적중전개복솔분별위2．0％（2/101）화3．2％（5/157），차이무통계학의의（P＝0．708）。수보조복강경조、복강경조화개복수술조적술후병발증발생솔분별위11．9％（12/101）、11．5％（18/157）화19．7％（26/132），차이무통계학의의（P＝0．100）。3조술후표본장도、하절연장도、청소림파결수목화양성림파결수목적차이무통계학의의（균P＞0．05）。수보조복강경조여복강경조환자적술후배기시간、진식시간화주원시간균명현단우개복수술조（균P＜0．01）。결론수보조복강경수술여복강경수술일양구유창상소화술후회복쾌등우세，가체도여개복수술일양적근기종류근치효과，단수보조복강경수술명현축단료수술시간。
Objective The aim of this study was to compare the short-term outcomes for hand-assisted, laparoscopic, and open resection for rectal cancer. Methods Three hundred ninety patients with rectal cancer who underwent curative resection between June 2009 and June 2012 were included. Patients were classified into a hand-assisted group (HALS, n=101), a laparoscopic surgery group (LS, n=157), and an open surgery group (OS, n=132). Patient and disease characteristics, operative parameters, postoperative morbidity, pathological results and length of recovery were compared among three groups. Results The mean operating time was (173±39) min for the HALS group, (231±61) min for the LS group, and (173 ±39) min for the OS group (P<0.01). Conversion ratesdid not differ between HALS and LS groups (2.0% vs 3.2%, P=0.708). The overall complication rates were 11.9%, 11.5%, and 19.7% in the HALS, LS and OS groups respectively (P=0.100). The specimen quality with a specimen length, distal resection margin, harvested lymph nodes, and positive lymph nodes did not differ among the three groups. Patients in the HALS and LS groups recovered significantly faster than those from the OS group. Conclusions This comparative study shows that HALS and LS can reproduce the equivalent short-term results of standard OS. HALS retained the minimal invasive advantages of LS, and significantly shorten the operation time.