手助腹腔镜与传统开腹直肠癌根治术的对比研究

doi:10.3877/cma.j.issn.2095-3224.2015.04.14

中华结直肠疾病电子杂志 ›› 2015, Vol. 04 ›› Issue (04) : 415 -418. doi: 10.3877/cma.j.issn.2095-3224.2015.04.14

所属专题：文献；

论著

手助腹腔镜与传统开腹直肠癌根治术的对比研究

朱玉萍¹, 冯海洋¹, 刘卓¹, 付志璇¹, 李德川¹^,^†(

)

^1. 310022　杭州，浙江省肿瘤医院结直肠外科

收稿日期:2015-06-14 出版日期:2015-08-25
通信作者: 李德川

Comparison of hand-assisted laparoscopic surgery and open approach in curative resection of rectal carcinoma

Yu-ping ZHU¹, Hai-yang FENG¹, Zhuo LIU¹, Zhi-xuan FU¹, De-chuan LI¹^,^†()

^1. Department of colorectal cancer surgery, Zhe jiang cancer hospital, Hangzhou 310012, China

Received:2015-06-14 Published:2015-08-25
Corresponding author: De-chuan LI
About author:
Corresponding author: LI De-chuan, Email: lidc@zjcc.org.cn

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目的

通过手助腹腔镜与开腹下直肠癌根治术的对比研究，评估手助腹腔镜在直肠癌根治手术中应用的优劣。

方法

对本院103例接受手助腹腔镜和开腹手术的直肠癌患者的基本临床资料、手术切口、术中出血、手术时间、术后恢复、病理结果、近期疗效等进行分析。

结果

两组患者的基本临床资料无统计学差异，手助腹腔镜组的手术切口长度、手术出血量、术后住院天数、术后镇痛、术后排气时间等方面明显优于开腹组，两组在手术时间、术后并发症发生率等方面无统计学差异。术后两组患者平均随访26个月，各自出现2例远处转移及复发，无切口种植情况。

结论

手助腹腔镜直肠癌根治术是安全的微创手术方式，都具有住院时间短、进食及肠道恢复快，疼痛减轻，出血量较少，手术彻底性良好的特点。

Objective

This prospective, randomized study compared the outcomes of hand-assisted laparoscopic surgery(HALS)with open approach resection of rectal carcionma.

Methods

103 rectal cancer patients received HALS and open approach surgery.The main outcome measures were the distance of tumor to anus, procedure time, blood loss, length of abdominal incision, post-operative abdominal drainage, return of bowel function, length of hospital stay, morbidity and pathology results.

Results

Patients in each group were similar with regard to general status and the histopathological features of tumours.Length of abdominal incision, surgical blood loss, post-operative hospital stay length, mean duration of narcotic analgesia, time to first passing flatus, and postoperative venous high nutrition application were better in HALS than open approach surgery.Procedure times and post-operative morbidity were similar in two group.At a median follow-up of 26 months, both of the groups occured two recurrences.

Conclusion

In this study, the HALS and laparoscopic surgery approaches for curative resection of rectal carcinoma was safe and effective and may offer several potential advantages to patients in their post-operative recovery.

Key words: Rectal carcinoma, HALS, Open surgery

表1 两组患者的基本临床资料表

指标		手助腹腔镜组(n＝52)	开腹组(n＝51)	P值
性别		?	?	?
?	男	30	27	?
?	女	22	24	0.694
年龄(y)		56.79±11.69	56.35±11.93	0.852
T分期		?	?	?
?	T1	9	10	?
?	T2	19	17	>0.05
?	T3	21	19	?
?	T4	3	5	?
淋巴结分期		?	?	?
?	N0	33	31	?
?	N1	14	12	>0.05
?	N2	5	8	?
淋巴结平均数(n)		16.29±7.04	17.24±6.74	0.488
淋巴结阳性率(%)		7.80	7.4	0.978
肿瘤至肛缘平均距离(cm)		5.79±2.96	5.76±2.70	?

表1 两组患者的基本临床资料表

指标		手助腹腔镜组(n＝52)	开腹组(n＝51)	P值
性别		?	?	?
?	男	30	27	?
?	女	22	24	0.694
年龄(y)		56.79±11.69	56.35±11.93	0.852
T分期		?	?	?
?	T1	9	10	?
?	T2	19	17	>0.05
?	T3	21	19	?
?	T4	3	5	?
淋巴结分期		?	?	?
?	N0	33	31	?
?	N1	14	12	>0.05
?	N2	5	8	?
淋巴结平均数(n)		16.29±7.04	17.24±6.74	0.488
淋巴结阳性率(%)		7.80	7.4	0.978
肿瘤至肛缘平均距离(cm)		5.79±2.96	5.76±2.70	?

表2 手术相关指标情况表

指标	手助腹腔镜组(n＝53)	开腹组(N＝51)	P值
手术时间(min)	153.65±39.07	146.47±37.00	0.354
手术切口长度(cm)	5.08±0.42	14.61±3.24	<0.01
手术失血量(ml)	137.21±78.61	161.76±65.26	0.088
手术术式	?	?	?
腹会阴联合(n)	12	10	?
直肠前切除(n)	31	36	>0.05
Hartmann(n)	9	6	?

表2 手术相关指标情况表

指标	手助腹腔镜组(n＝53)	开腹组(N＝51)	P值
手术时间(min)	153.65±39.07	146.47±37.00	0.354
手术切口长度(cm)	5.08±0.42	14.61±3.24	<0.01
手术失血量(ml)	137.21±78.61	161.76±65.26	0.088
手术术式	?	?	?
腹会阴联合(n)	12	10	?
直肠前切除(n)	31	36	>0.05
Hartmann(n)	9	6	?

表3 术后观察指标情况表

指标	手助腹腔镜组(n＝52)	开腹组(N＝51)	P值
术后平均止痛时间(d)	1.90±1.36	3.14±1.27	<0.01
术后腹腔平均引流量(ml)	302.88±193.30	335.69±192.19	0.290
术后排气时间(h)	67.58±22.51	78.92±19.96	0.008
术后静脉高营养使用时间(d)	4.54±1.70	5.12±1.56	0.074
进食流质时间(d)	4.23±1.69	4.90±1.20	0.022
术后住院天数(d)	7.73±1.81	8.88±1.89	0.002
并发症(n)	4(7.69)	4(7.84)	0.977

表3 术后观察指标情况表

指标	手助腹腔镜组(n＝52)	开腹组(N＝51)	P值
术后平均止痛时间(d)	1.90±1.36	3.14±1.27	<0.01
术后腹腔平均引流量(ml)	302.88±193.30	335.69±192.19	0.290
术后排气时间(h)	67.58±22.51	78.92±19.96	0.008
术后静脉高营养使用时间(d)	4.54±1.70	5.12±1.56	0.074
进食流质时间(d)	4.23±1.69	4.90±1.20	0.022
术后住院天数(d)	7.73±1.81	8.88±1.89	0.002
并发症(n)	4(7.69)	4(7.84)	0.977

[1]	Pendlimari R, Holubar SD, Pattan-Arun J, et al.Hand-assisted laparoscopic colon and rectal cancer surgery: feasibility, short-term, and oncological outcomes.Surgery, 2010, 148(2): 378-385.
[2]	Dols LF, Kok NF, Ijzermans JN.Live donor nephrectomy: A review of evidence for surgical techniques.Transpl Int, 2010, 23: 121-130.
[3]	Baik SH, Gincherman M, Mutch MG, et al.Laparoscopic vs open resection for patients with rectal cancer: comparison of perioperative outcomes and long-term survival.Dis Colon Rectum, 2011, 54(1): 6-14.
[4]	Braga M, Vignali A, Gianotti L, et al.Laparoscopic versus open colorectal surgery: a randomized trial on short-term outcome.Ann Surg, 2002, 236: 759-66.
[5]	Schirmer BD.Laparoscopic colon resection.Surg Clin North Am, 1996, 76: 571-583.
[6]	Tekkis PP, Senagore AJ, Delaney CP, et al.Evaluation of the learning curve in laparoscopic colorectal surgery: comparison of right-sided and left-sided resections.Ann Surg, 2005, 242: 83-91.
[7]	Liu FL, Lin JJ, Ye F, et al.Hand-assisted laparoscopic surgery versus the open approach in curative resection of rectal cancer.J Int Med Res, 2010, 38: 916-922.
[8]	Meshikhes AW, El Tair M, Al Ghazal T. Hand-assisted laparoscopic colorectal surgery: initial experience of a single surgeon.Saudi J Gastroenterol, 2011, 17(1): 16-19.
[9]	Samalavicius NE, Gupta RK, Dulskas A, et al.Clinical outcomes of 103 hand-assisted laparoscopic surgeries for left-sided colon and rectal cancer: single institutional review.Ann Coloproctol, 2013, 29(6): 225-230.

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