腹腔镜在直肠癌手术中应用价值.docVIP

腹腔镜在直肠癌手术中应用价值 　　[摘要] 目的：探讨腹腔镜在直肠癌术前探查的应用价值。方法：回顾性分析本院2007年8月～2009年8月收治的34例直肠癌进展期患者的临床资料，其中18例进行腹腔镜探查下的手术治疗，16例进行开腹探查，比较两组患者行肿瘤根治术的例数，并比较临床疗效。结果：腹腔镜T分期与术后病理检查的结果符合率为88.9%（16/18），术前临床T分期与术后病理检查结果符合率61.1%（11/18），两组比较差异有统计学意义（P0.05）。结论：腹腔镜可避免不必要的剖腹探查，创伤小，能对进展期直肠癌作出准确的诊断和分期，有助于手术决策的制定，改善患者的预后。 　　[关键词] 直肠癌；腹腔镜探查；剖腹探查；应用价值； 　　[中图分类号] R730.56[文献标识码]B [文章编号]1674-4721（2011）06（b）-131-02 　　 　　The value of applications of laparoscopic surgery in rectal cancer 　　WANG Gengtang, LIU Siyu, TAN Hongbo, TANG Jianming, HE Aijun 　　The First Peoples Hospital of Shaoyang City, Hunan Province, Shaoyang 422001, China 　　[Abstract] Objective: To explore the value of applications used laparoscopic surgery in rectal cancer. Methods: Retrospective analyzed the clinical data of 34 cases of advanced colorectal cancer patients in our hospital from August 2007 to August 2009, 18 patients were applicated of laparoscopic exploration in operation therapy, 16 patients treated with exploratory laparotomy. All patients were compared the number of cases radical operation, and clinical efficacy of parity. Results: Laparoscopic T staging and the pathological examination of the results of compliance was 88.9% (16/18), preoperative clinical T stage and the pathological findings consistent with rates of 61.1% (11/18), there were significant differences between the two groups (P0.05). Conclusion: Laparoscopy can avoid unnecessary laparotomy, trauma, advanced cancer can make an accurate diagnosis and staging, helps to surgical decision making, improve patient prognosis. 　　[Key words] Rectal cancer; Laparoscopic surgery; Exploratory laparotomy; The value of applications 　　 　　直肠癌（rectal cancer）是胃肠道中常见的恶性肿瘤，发病率仅次于胃癌和食道癌，是大肠癌的最常见部分（占65%左右）。绝大多数患者在40岁以上，30岁以下者约占15%，男性较多见，男女之比为（2～3）∶1。直肠癌是一种生活方式病，目前它已在癌症排行榜中跃居第二位。所以，饮食和生活方式是癌症的祸根。由于成因和症状的相似，直肠癌通常和结肠癌被一同提及[1]。进展期直肠癌占临床直肠癌患者的80%以上，3年生存率在30%左右，手术是最有效的治疗方法，但手术仅能有选择地对患者进行根治性治疗、姑息治疗或肠造瘘[2]。腹膜转移是进展期直肠癌常见的转移方式，也是最重要的致死因素之一。由于术前临床分期不准确，至少有23%的直肠癌患者由于无法手术切除而只行开腹手术。为