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中华结直肠疾病电子杂志

中华结直肠疾病电子杂志 ›› 2017, Vol. 06 ›› Issue (05) : 397 -401. doi: 10.3877/cma.j.issn.2095-3224.2017.05.009

所属专题： 文献；

论著

腹腔镜直肠癌根治术与开腹直肠癌根治术的临床对照研究
徐传奇1, 史友权2, 吕剑3, 蒋学通4, 王森5, 汤东4, 王伟4, 崇杨4, 徐明皓2, 张琪6, 王道荣,4   
  1. 1. 225001　扬州，江苏省苏北人民医院胃肠中心；214500　靖江，江苏省靖江市人民医院普外科
    2. 225001　扬州，江苏省苏北人民医院胃肠中心；116044　大连医科大学
    3. 214500　靖江，江苏省靖江市人民医院普外科
    4. 225001　扬州，江苏省苏北人民医院胃肠中心
    5. 210000　南京医科大学附属第一临床医学院
    6. 225001　扬州，江苏省苏北人民医院胃肠中心；225001　扬州大学医学院
  • 收稿日期:2017-03-22 出版日期:2017-10-25
  • 通信作者: 王道荣
  • 基金资助:
    重点病种规范化诊疗项目(No.BE2015664)

Comparison of the clinical efficacy of laparoscopic and open radical resection of rectal cancer

Chuanqi Xu1, Youquan Shi2, Jian Lyu3, Xuetong Jiang4, Sen Wang5, Dong Tang4, wei Wang4, Yang Chong4, Minghao Xu2, Qi Zhang6, Daorong Wang,4   

  1. 1. Department of General Surgery of Subei People′s Hospital of Jiangsu province, Yangzhou 225001, China; Department of General Surgery of Jingjiang People′s Hospita l, Jingjiang 214500, China
    2. Department of General Surgery of Subei People′s Hospital of Jiangsu province, Yangzhou 225001, China; Dalian Medical University, Dalian 116044, China
    3. Department of General Surgery of Jingjiang People′s Hospita l, Jingjiang 214500, China
    4. Department of General Surgery of Subei People′s Hospital of Jiangsu province, Yangzhou 225001, China
    5. The First Clinical College of Nanjing Medical University, Nanjing 210000, China
    6. Department of General Surgery of Subei People′s Hospital of Jiangsu province, Yangzhou 225001, China; Yangzhou University Medical Academy, Yangzhou 225001, China
  • Received:2017-03-22 Published:2017-10-25
  • Corresponding author: Daorong Wang
  • About author:
    Corresponding author: Wang Daorong, Email:
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徐传奇, 史友权, 吕剑, 蒋学通, 王森, 汤东, 王伟, 崇杨, 徐明皓, 张琪, 王道荣. 腹腔镜直肠癌根治术与开腹直肠癌根治术的临床对照研究[J/OL]. 中华结直肠疾病电子杂志, 2017, 06(05): 397-401.

Chuanqi Xu, Youquan Shi, Jian Lyu, Xuetong Jiang, Sen Wang, Dong Tang, wei Wang, Yang Chong, Minghao Xu, Qi Zhang, Daorong Wang. Comparison of the clinical efficacy of laparoscopic and open radical resection of rectal cancer[J/OL]. Chinese Journal of Colorectal Diseases(Electronic Edition), 2017, 06(05): 397-401.

目的

分析比较腹腔镜与开腹直肠癌根治术的临床疗效。

方法

选取江苏省苏北人民医院胃肠外科自2009年9月至2015年1月期间手术的380例直肠癌患者的临床数据，其中腹腔镜下直肠癌根治术（腔镜组）190例，开腹直肠癌根治术（开腹组）190例，回顾性分析两组患者的临床资料，对比分析两组样本的术中出血量、手术时间、淋巴结清扫数、术后引流量，术后并发症、术后住院时间、术后随访等数据。

结果

两组患者在术中出血量（t=-9.06，P<0.001）、术中淋巴结清扫数（t=2.07，P=0.039）、术后住院时间（t=2.87，P=0.004）、手术时间（t=5.43，P<0.001）、切口感染（Χ2=4.49，P=0.03）、性功能障碍（Χ2=4.43，P=0.04）、肠梗阻（Χ2=4.49，P=0.03）等方面差异具有统计学意义，两组在术后3天引流量（t=1.024，P=0.306）、转移淋巴结数（t=0.70，P=0.484）和术后生存率（Χ2=0.74，P=0.39）方面差异无统计学意义。

结论

腹腔镜与开腹直肠癌根治术都是安全可行的无瘤手术方式，两种方式各有优劣，目前仍缺乏相关的前瞻性临床随机对照试验。

关键词: 直肠肿瘤, 腹腔镜, 开腹手术, 疗效, 并发症
Objective

To compare the curative effect of laparoscopic and open radical resection of rectal cancer.

Methods

The clinical data of 380 patients with rectal cancer that had received operation from September 2009 to January 2015 in Gastrointestinal Surgery Department of Subei People Hospital were selected, and there were 190 cases of laparoscopic assisted rectal cancer radical resection (laparoscopic group), and 190 cases of open rectal cancer radical resection(open group).A retrospective analysis was conducted on the clinical data of two groups and the intraoperative blood loss, operative length, lymph node dissection number, postoperative drainage volume, postoperative complications, postoperative discharge time, postoperative follow-up data of two groups were compared and analyzed.

Results

Patients from two groups had significant difference in intraoperative blood loss (t=9.06, P<0.0001) , lymph node dissection number (Χ2=2.07, P=0.039), postoperative hospital stay (Χ2=2.87, P=0.004), operative length (t=5.43, P<0.001), infection of incision (Χ2=4.49, P=0.03), Sexual dysfunction (Χ2=4.43, P=0.04) and intestinal obstruction (Χ2=4.49, P=0.03). The laparoscopic assisted rectal cancer radical resection had less intraoperative blood loss, more intraoperative lymph node dissection number, shorter postoperative hospital stay, less infection of incision, less Intestinal obstruction and less Sexual dysfunction etc., while the open group had shorter operation length. They had no statistical significance in post-operative drainage volume within three days (t=1.024, P=0.306), the number of lymph node metastasis (Χ2=0.70, P=0.484), and survival rate after operation (Χ2=0.74, P=0.39).

Conclusion

Laparoscopic and open radical resection of rectal cancer are safe and feasible surgical approach, both ways have their own advantages and disadvantages, is still lack of related prospective clinical randomized controlled trials.

Key words: Rectal neoplasms, Laparoscopes, Open surgery, Efficacy, Complication
表1 两组病例的一般临床资料分析
分组 例数 性别 年龄 手术方式 TNM分期
男 女 Dixon手术 Miles手术 I II III
腔镜组 190 116 74 61.78±11.16 102 88 55 87 48
开腹组 190 128 62 64.25±11.13 107 83 60 83 47
t或Χ2值 1.65 2.16 0.27 0.32
P值 0.20 0.27 0.61 0.85
表2 两组病例的手术相关资料分析
分组 例数 术中出血量（ml） 术中淋巴结清扫（枚） 转移淋巴结数（枚） 手术时间（分钟） 术后3天引流量总计（ml） 术后住院时间（天）
腔镜组 190 113.35±17.23 9.41±2.33 2.17±0.95 167.32±42.71 328.81±30.52 11.83±3.91
开腹组 190 132.46±23.42 8.92±2.27 2.00±0.80 142.61±45.95 325.49±32.64 13.33±6.04
t值 -9.06 2.07 0.70 5.43 1.024 -2.87
P值 <0.001 0.039 0.484 <0.001 0.306 0.004
表3 两组病例的术后并发症相关资料分析
分组 例数 切口感染 吻合口漏 排尿困难 输尿管损伤 性功能障碍 肠梗阻 并发症总计
腔镜组 190 5 8 4 5 15 5 42
开腹组 190 14 5 2 3 28 14 66
Χ2值 4.49 0.72 0.17 0.13 4.43 4.49 7.45
P值 0.03 0.40 0.41 0.47 0.04 0.03 0.09
表4 两组病例的术后随访资料分析
分组 例数 无瘤生存病例 复发与转移病例 死亡病例
腔镜组 190 128 26 36
开腹组 190 120 27 43
Χ2值 0.74 0.22 0.78
P值 0.39 0.88 0.38
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