腹腔镜和开腹直肠癌全系膜切除的对照研究.DOCVIP

临床医学论文-腹腔镜和开腹直肠癌全系膜切除的对照研究 ????????????? 作者：王道荣 孙跃明 诸林海 练乐尧 仇明 【摘要】目的：探讨腹腔镜下行直肠癌全直肠系膜切除根治术的临床效果。方法：24例直肠癌患者分为两组。腹腔镜组：采用全直肠系膜切除（LCR）12例。采用经腹腔镜下联合应用超声刀循盆筋膜壁层和脏层的间隙行锐性游离全直肠系膜，切除一个不间断的直肠整体标本。开腹组：12例，采用常规开腹手术。比较两组围手术期的状况、肿瘤切除的彻底性、肠旁淋巴结清扫数量。结果：两组切除标本的直肠系膜均完整，腹腔镜组中无中转开腹，腹腔镜组与开腹组淋巴结数分别为7.9±0.7个与8.1±0.9个（P＞0.05）；远端直肠均无癌残留；腹腔镜组手术后肠功能恢复早［(45±4.5）h VS (79±11.6)h,P＞0.05］，手术中出血量少［(185±41)ml VS (380±48)ml,P＜0.01］。结论：经腹腔镜行全直肠系膜切除术（TME）手术是行之有效的，具有创伤小，恢复快等忧点。 ??? 【关键词】直肠肿瘤?腹腔镜?直肠全系膜切除术 ??? Clinical comparison of laparoscopic and open total mesorectal excision for rectal cancer ??? 【ABSTRACT】Objective:To evaluate the feasibility,safety of laparoscoplic TME and compare the shortterm outcome of laparoscopic procedure with laparotomy for rectal carcinoma.Methods:24 patients with rectal carcinoma were included in a prospective nonrandomized study.The patients were assigned to laparoscopic group(n=12)or laparotomy open procedure group(n=12),case selection,Surgical technique clinical and oncological results were reviewed.Results:Operative time was longer in laparoscopic group than in laparotomy group(209±26min,vs 164±23min,P＜0.05),and intraoperative blood loss were less in laparoscopic group than in the laparotomy group(185±41 ml vs 380ml±48ml,P＜0.01).An earlier recovery of bowel function was observed after laparoscopic Surgery(45±4.5h vs 79±11.6h,P＜0.05).No anastomotic leakage was found in both groups.The pathologic examination showed that the length of resected specimen and the mean number of lymph nodes in laparoscopic group were comparable to those in laparotomy group.Conclusion:Laparoscoplic TME is a feasible and effective procedure.The present study demonstrates that laparotocopic surgery for rectal carcinoma is feasible and safe procedure and oncological results are comparable to the laparotomy with a favorableshortterm outcome. ??? 【KEY WORDS】Rectal neoplasms?Laparoscopes?Total mesorectal excision??? 低位直肠癌全直肠系膜切除术（TME）其效果优于传统手术方法［1］，由于腹腔镜器械的发展和操作技术水平的提高，腹腔镜辅助TME手术治疗直肠中下段癌在技术上已不断成熟。为