中华胃肠外科杂志
中華胃腸外科雜誌
중화위장외과잡지
CHINESE JOURNAL OF GASTROINTESTINAL SURGERY
2013年
6期
565-569
,共5页
周彤%张广军%刘作良%田洪鹏
週彤%張廣軍%劉作良%田洪鵬
주동%장엄군%류작량%전홍붕
直肠肿瘤,超低位%经括约肌间切除%腹腔镜%治疗效果
直腸腫瘤,超低位%經括約肌間切除%腹腔鏡%治療效果
직장종류,초저위%경괄약기간절제%복강경%치료효과
Rectal neoplasms,ultra-low%Intersphincteric resection%Laparoscopy%Treatment outcomes
目的 比较腹腔镜与开腹经括约肌间切除术(ISR)治疗超低位直肠癌的安全性、可行性及临床疗效.方法 回顾性分析2007年1月至2010年1月间在川北医学院附属医院接受腹腔镜ISR手术的27例超低位直肠癌患者(腹腔镜组)的临床资料,并选取同期行开腹ISR手术的41例超低位直肠癌患者作为对照(开腹组).比较两组患者的手术指标、术后并发症、肿瘤相关指标、术后肛门功能及预后.结果 腹腔镜组均顺利完成ISR手术,无一例中转开腹.与开腹组相比,腹腔镜组手术时间明显延长[(242.2±42.5) min比(199.1±44.3)min,P=0.000],术中出血量明显减少[(150.5±102.2) ml比(258.4±149.2) ml,P=0.002],术后肛门排气时间[(2.9±1.1)d比(3.6±1.5)d,P=0.032]和恢复正常饮食时间[(6.6±1.2)d比(7.5±1.7)d,P=0.012]及术后住院时间[(7.7±1.4)d比(9.1±2.4)d,P=0.006]均明显缩短.腹腔镜组与开腹组淋巴结清扫数量[(14.1±4.1)枚比(16.4±6.8)枚,P=0.113]、远切缘长度[(1.4±0.7)cm比(1.6±0.8) cm,P=0.311]及环周切缘阳性率[7.4％(2/27)比2.4％(1/41),P=0.709]方面的差异均无统计学意义.两组术后并发症发生率、术后局部复发率、远处转移率及术后肛门功能的差异均无统计学意义(P＞0.05).结论 腹腔镜ISR手术治疗超低位直肠癌术中出血少、术后恢复快,可取得与开腹手术相似的肿瘤根治效果,安全可行.
目的 比較腹腔鏡與開腹經括約肌間切除術(ISR)治療超低位直腸癌的安全性、可行性及臨床療效.方法 迴顧性分析2007年1月至2010年1月間在川北醫學院附屬醫院接受腹腔鏡ISR手術的27例超低位直腸癌患者(腹腔鏡組)的臨床資料,併選取同期行開腹ISR手術的41例超低位直腸癌患者作為對照(開腹組).比較兩組患者的手術指標、術後併髮癥、腫瘤相關指標、術後肛門功能及預後.結果 腹腔鏡組均順利完成ISR手術,無一例中轉開腹.與開腹組相比,腹腔鏡組手術時間明顯延長[(242.2±42.5) min比(199.1±44.3)min,P=0.000],術中齣血量明顯減少[(150.5±102.2) ml比(258.4±149.2) ml,P=0.002],術後肛門排氣時間[(2.9±1.1)d比(3.6±1.5)d,P=0.032]和恢複正常飲食時間[(6.6±1.2)d比(7.5±1.7)d,P=0.012]及術後住院時間[(7.7±1.4)d比(9.1±2.4)d,P=0.006]均明顯縮短.腹腔鏡組與開腹組淋巴結清掃數量[(14.1±4.1)枚比(16.4±6.8)枚,P=0.113]、遠切緣長度[(1.4±0.7)cm比(1.6±0.8) cm,P=0.311]及環週切緣暘性率[7.4％(2/27)比2.4％(1/41),P=0.709]方麵的差異均無統計學意義.兩組術後併髮癥髮生率、術後跼部複髮率、遠處轉移率及術後肛門功能的差異均無統計學意義(P＞0.05).結論 腹腔鏡ISR手術治療超低位直腸癌術中齣血少、術後恢複快,可取得與開腹手術相似的腫瘤根治效果,安全可行.
목적 비교복강경여개복경괄약기간절제술(ISR)치료초저위직장암적안전성、가행성급림상료효.방법 회고성분석2007년1월지2010년1월간재천북의학원부속의원접수복강경ISR수술적27례초저위직장암환자(복강경조)적림상자료,병선취동기행개복ISR수술적41례초저위직장암환자작위대조(개복조).비교량조환자적수술지표、술후병발증、종류상관지표、술후항문공능급예후.결과 복강경조균순리완성ISR수술,무일례중전개복.여개복조상비,복강경조수술시간명현연장[(242.2±42.5) min비(199.1±44.3)min,P=0.000],술중출혈량명현감소[(150.5±102.2) ml비(258.4±149.2) ml,P=0.002],술후항문배기시간[(2.9±1.1)d비(3.6±1.5)d,P=0.032]화회복정상음식시간[(6.6±1.2)d비(7.5±1.7)d,P=0.012]급술후주원시간[(7.7±1.4)d비(9.1±2.4)d,P=0.006]균명현축단.복강경조여개복조림파결청소수량[(14.1±4.1)매비(16.4±6.8)매,P=0.113]、원절연장도[(1.4±0.7)cm비(1.6±0.8) cm,P=0.311]급배주절연양성솔[7.4％(2/27)비2.4％(1/41),P=0.709]방면적차이균무통계학의의.량조술후병발증발생솔、술후국부복발솔、원처전이솔급술후항문공능적차이균무통계학의의(P＞0.05).결론 복강경ISR수술치료초저위직장암술중출혈소、술후회복쾌,가취득여개복수술상사적종류근치효과,안전가행.
Objective To compare the clinical and oncological outcomes between laparoscopic and open intersphincteric resection in patients with low rectal cancer.Methods From January 2007 to January 2010,patients with low rectal cancer treated by laparoscopic or open intersphincteric resection were included in a retrospective comparative study.Patients were classified into laparoscopy group (n=27) and open group (n=41).The operative procedures,postoperative complications,anal function and clinicopathological data were compared.Results Compared to the open group,the laparoscopic group had longer operative time[(242.2±42.5) min vs.(199.1±44.3) min,P=0.000],less blood loss[(150.5± 102.2) ml vs.(258.4±149.2) ml,P=0.002],faster recovery of bowel function[(2.9±1.1) d vs.(3.6± 1.5) d,P=0.032] and resumption of regular diet[(6.6±1.2) d vs.[(7.5±1.7) d,P=0.012],and shorter postoperative hospital stay [(7.7±1.4) d vs.(9.1±2.4) d,P=0.006].The postoperative complication rate between the laparoscopic and open groups was not significantly different [18.5％(5/27) vs.19.5％ (8/41),P=0.464].Oncological parameters were comparable between the two groups including lymph node harvested [(14.1±4.1) vs.(16.4±6.8),P=0.113],distal resection margin [(1.4±0.7) cm vs.(1.6±0.8) cm,P=0.311],and circumferential margin [7.4％(2/27) vs.2.4％(1/41),P=0.709].Local recurrence rates in laparoscopic and open groups were 7.4％ (2/27) and 2.4％ (1/41),and distant metastasis rates were 0 and 4.9％ (2/41) respectively,and the differences were not significant (both P＞0.05).Conclusions Laparoscopic intersphincteric resection possesses same efficacy of open intersphincteric resection with less blood loss,shorter recovery time and hospital stay,and similar oncological outcomes,and no increased postoperative morbidity and mortality.
