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目的:探讨腹腔镜结直肠癌根治术的安全性、有效性及可行性。方法:将大连大学附属中山医院腹腔镜外科2005年3月—2010年8月行腹腔镜结直肠癌根治术41例患者及同期行开腹结直肠癌根治术的41例患者临床资料进行对照研究。结果:两组术中、术后均无严重并发症和死亡病例,腹腔镜组有2例中转开腹手术。腹腔镜组手术时间长于开腹组([180.73±19.06)min vs(136.15±11.82)min,P=0.00]。腹腔镜组术中失血量明显少于开腹组([103.59±20.90)mL vs(201.34±28.96)mL,P=0.00]。清除的淋巴结总数量2组间差异无统计学意义([12.73±0.85)vs(13.1±1.49)枚,P=0.183]。直肠前切除远端切缘长度腹腔镜组明显长于开腹组([3.86±0.51)cm vs(3.48±0.51)cm,P=0.001]。腹腔镜组术后排气时间和下床时间明显早于开腹组([2.96±0.57)d vs(3.35±0.45)d,P=0.001]([4.91±0.82)d vs(5.67±0.95)d,P=0.00]。腹腔镜组住院时间明显短于开腹组([10.62±0.43)d vs(14.54±0.97)d,P=0.00],但住院费用仍明显高于开腹组([3.59±0.71)×104元vs(2.42±0.41)×104元,P=0.00]。2组的3年生存率差异无统计学意义[87.1%(27/31)vs 88.57%(31/35),P=0.286]。结论:腹腔镜技术在结直肠癌治疗上安全、可行,并具有创伤小、恢复快,痛苦少等优点,是目前结直肠癌的一种有效、安全且微创的治疗方式。
Objective: To investigate the safety, efficacy and feasibility of laparoscopic radical resection of colorectal cancer. Methods: The clinical data of 41 patients undergoing laparoscopic radical resection of colorectal cancer and 41 patients undergoing open radical resection of colorectal cancer undergoing laparoscopic surgery at Zhongshan Hospital Affiliated to Dalian University from March 2005 to August 2010 were compared . Results: There were no serious complications and deaths in both groups during operation and after operation. Laparotomy group had 2 cases of laparotomy. The laparoscopic group had longer operation time than the open group ([180.73 ± 19.06] min vs (136.15 ± 11.82) min, P = 0.00]. Blood loss in laparoscopic group was significantly less than that in open group ([103.59 ± 20.90] mL vs (201.34 ± 28.96) mL, P = 0.00]. There was no significant difference in the total number of lymph nodes removed between the two groups ([12.73 ± 0.85 vs 13.1 ± 1.49, P = 0.183]. The length of the distal end of the anterior resection was significantly longer in the laparoscopic group than in the open group ([3.86 ± 0.51] cm vs (3.48 ± 0.51) cm, P = 0.001]. The laparoscopic group had significantly shorter duration of extubation and ambulation than that of the laparotomy group ([2.96 ± 0.57] d vs (3.35 ± 0.45) d, P = 0.001] ([4.91 ± 0.82] d vs (5.67 ± 0.95) d, P = 0.00]. The length of hospital stay in laparoscopic group was significantly shorter than that in open group ([10.62 ± 0.43] d vs (14.54 ± 0.97) d, P = 0.00], but the hospitalization cost was still significantly higher than that in open group ([3.59 ± 0.71] × 104 vs (2.42 ± 0.41) × 104, P = 0.00]. There was no significant difference in 3-year survival rates between the two groups (87.1% vs 27.5% vs. 88.57%, P = 0.286). Conclusion: Laparoscopic technique is safe and feasible in the treatment of colorectal cancer. It has the advantages of less trauma, faster recovery and less pain. It is an effective, safe and minimally invasive treatment for colorectal cancer.