中国普外基础与临床杂志

中国普外基础与临床杂志

低位直肠癌腹腔镜和开腹 Miles 手术的近期疗效对比分析

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目的 探讨腹腔镜 Miles 手术的肿瘤根治效果和短期疗效。 方法 回顾性分析 2012 年 3 月至 2017 年 3 月期间吉林大学中日联谊医院完成的 119 例低位直肠癌 Miles 手术患者的临床资料,其中行腹腔镜手术者 65 例(腹腔镜组),行开腹手术者 54 例(开腹组),比较 2 组患者的手术相关指标、病理学结果、康复和并发症情况。 结果 腹腔镜组和开腹组患者的性别、年龄、体质量指数、肿瘤距肛缘距、病理类型、病理 T 分期和 N 分期比较差异均无统计学意义(P>0.05)。与开腹组相比,腹腔镜组的手术时间显著延长(t=6.035,P=0.002),但肠功能恢复时间(t=4.919,P<0.001)、自主下床活动时间(t=2.2207,P<0.001)和术后住院时间(t=3.795,P=0.025)明显缩短,2 组患者的术中出血量(t=0.154,P=0.698)和淋巴结清扫数目(t=0.532,P=0.595)比较差异均无统计学意义;腹腔镜与开腹组患者的切口感染、造口塌陷或坏死、输尿管损伤、心功能衰竭、肺部感染及下肢血栓并发症发生率比较差异均无统计学意义(P>0.05),但开腹组的总并发症率明显高于腹腔镜组(χ2=7.174,P=0.009)。 结论 腹腔镜 Miles 手术不但能获得与开腹手术接近的淋巴结清扫数目,而且其术后肠功能恢复更快,自主下床活动时间更早,术后住院时间更短,总并发症率更低。

Objective To evaluate short-term effect of laparoscopic and open Miles operations for lower rectal carcinoma. Methods A total of 119 patients with lower rectal carcinoma were retrospectively collected from March 2012 to March 2017 in this hospital, among which 65 were in the laparoscopic operation group and 54 in the open operation group. The perioperative data, pathological results, recovery courses, and complications were compared between the two groups. Results Compared with the open operation group, the laparoscopic group showed a longer operation time (t=6.035, P=0.002), quicker bowel function recovery (t=4.919, P<0.001), faster off-bed activity (t=2.2207, P<0.001), and shorter hospital stay time (t=3.795, P=0.025); The intraoperative blood loss (t=0.1536, P=0.698) and the number of harvested lymph nodes (t=0.532, P=0.595) were similar between the two groups. The laparoscopic operation group showed a significant lower total complication rate (χ2=7.174, P=0.009) as compared with the open operation group, but the incision infection, urinary tract injury, lung infection, thrombosis of lower extremities, etc. had no significant differences between the two groups (P>0.05). Conclusion Laparoscopic Miles operation improves postoperative recovery and reduces postoperative complications as compared with open approach in treatment of lower rectal cancer, with similar oncological and short-term results.

关键词: 低位直肠癌; 腹腔镜手术; 开腹手术

Key words: lower rectal carcinoma; laparoscopy; open operation

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