CAJ | 학술논문

目的探讨免辅助切口腹腔镜对低位直肠癌行根治术的可行性及近期临床疗效.方法回顾性分析2002-2005年行腹腔镜免辅助切口对低位直肠癌行根治术69例的临床资料(研究组),并与同期68例行辅助切口腹腔镜低位直肠癌术(对照组)进行对比研究.统计学分析:计量资料采用t检验,计数资料采用X2检验.结果两组均顺利行直肠癌根治性切除,保肛率100%,无中转开腹及严重并发症.对照组和研究组手术时间分别为(150±25)min和(130±22)min(t=4.97,P＜0.05),住院费用分别为(17900±850)元和(9900±750)元(t=58.43,P＜0.05),腹部切口长度分别为(5±1.5)cm和0 cm(t=27.69,P＜0.05).对照组与研究组术中出血量分别为(75±26)ml和(77±23)ml(t=0.47,P＞0.05),清除淋巴结数量分别为(11.5±2.3)枚和(12.1±1.6)枚(t=1.77,P＞0.05),切除标本长度为(15.5±3.2)cm和(15.8±3.5)cm(t=0.52,P＞0.05),肿瘤下缘距远切端距离为(2.5±0.6)cm和(2.6±0.5)cm(t=1.06,P＞0.05).术后胃肠功能恢复时间分别为(48±2.3)h和(48±3.1)h(t=0.00,P＞0.05),手术后镇痛剂使用率分别为88%和86%(X~2=0.05,P＞0.05).所有患者均获随访45～79(平均59.9)个月.研究组术后9个月排便功能基本正常.两组1、3年肿瘤复发率分别为0、0和3%、1%,1、3年生存率分别为99%、97%和96%、96%,差异无统计学意义(X~2=0.00、0.32、0.35、0.15,P＞0.05).结论免辅助切口腹腔镜低位直肠癌手术符合肿瘤学根治的原则,具有可行性.与传统腹腔镜术式相比,该技术节省手术时间及住院费用.
목적 탐토면보조절구복강경대저위직장암행근치술적가행성급근기림상료효.방법 회고성분석2002-2005년행복강경면보조절구대저위직장암행근치술69례적림상자료(연구조),병여동기68례행보조절구복강경저위직장암술(대조조)진행대비연구.통계학분석:계량자료채용t검험,계수자료채용X2검험.결과 량조균순리행직장암근치성절제,보항솔100%,무중전개복급엄중병발증.대조조화연구조수술시간분별위(150±25)min화(130±22)min(t=4.97,P＜0.05),주원비용분별위(17900±850)원화(9900±750)원(t=58.43,P＜0.05),복부절구장도분별위(5±1.5)cm화0 cm(t=27.69,P＜0.05).대조조여연구조술중출혈량분별위(75±26)ml화(77±23)ml(t=0.47,P＞0.05),청제림파결수량분별위(11.5±2.3)매화(12.1±1.6)매(t=1.77,P＞0.05),절제표본장도위(15.5±3.2)cm화(15.8±3.5)cm(t=0.52,P＞0.05),종류하연거원절단거리위(2.5±0.6)cm화(2.6±0.5)cm(t=1.06,P＞0.05).술후위장공능회복시간분별위(48±2.3)h화(48±3.1)h(t=0.00,P＞0.05),수술후진통제사용솔분별위88%화86%(X~2=0.05,P＞0.05).소유환자균획수방45～79(평균59.9)개월.연구조술후9개월배편공능기본정상.량조1、3년종류복발솔분별위0、0화3%、1%,1、3년생존솔분별위99%、97%화96%、96%,차이무통계학의의(X~2=0.00、0.32、0.35、0.15,P＞0.05).결론 면보조절구복강경저위직장암수술부합종류학근치적원칙,구유가행성.여전통복강경술식상비,해기술절성수술시간급주원비용.
Objective To study the feasibility and curative effect of ineisionless laparoscopic total mesorectal excision of low rectal carcinoma in which an abdominoperineal resection was conducted without an accessory incision for the removal of the tumor containing bowel segment.Methods From January 2002 to January 2005,69 low rectal carcinoma (＜ 7 cm from the anal verge) patients undergoing incisionless laparoscopic total mesorectal excision (study group) ,in comparison with 68 patients receiving traditional laparoseopic assisted total mesorectal excision(control group).The operative procedures,clinicopathological data and short-term outcomes were compared.Results All the patients accepted laparoscopic operation successfully.The operating time in control group and study group was (150±25) min versus (130±22) min (t = 4.97,P ＜ 0.05),the hospital fee was (17900 ± 850) RMB yuan versus (9900±750) RMB yuan (t =58.43,P＜0.05),the length of abdomen incision was (5 ± 1.5) cm versus 0 cm (t = 27.69,P ＜ 0.05),the blood loss was (75± 26) ml versus (77 ±23) nd(t = 0.47,P ＞ 0.05),the number of lymph node dissected was (11.5±2.3) versus (12.1 ±1.6) (t =1.77,P＞0.05),the resected specimen length was (15.5 ± 3.2) cm versus (15.8 ± 3.5) cm (t = 0.52,P ＞ 0.05),the negative distal margin was (2.5 ±0.6) cm versus (2.6 ± 0.5) cm (t = 1.06,P ＞ 0.05),the time of bowel function recovery was (48 ±2.3) h versus (48 ±3.1) h (t =0.00,P ＞0.05) and the use of analgetics was 88% versus 86% (X~2 =0.05,P ＞0.05).All the patients were followed-up from 45 months to 79 months (average 59.9 months).The 1-,3-year recurrent rate and survival rate were 0,3% and 99% ,96% in study group,and those in the control group were 0,1% and 97%,96% respectively,with the difference being not significant (X~2 = 0.00,0.32,0.35,0.15,P ＞ 0.05).Patients in both group all regained satisfactory bowel continence 9 months after operation.Conclusions Incisionless laparoscopic total mesorectal excision with anal preservation is in line with oncologic principle,and a safe and feasible approach to the surgical treatment of lower rectal cancer,with the advantage of shorter operation time,shorter hospital fee and more cosmetic.