2019 年第 7 期 第 14 卷

腹腔镜与开腹直肠癌全直肠系膜切除术的安全性及远期临床疗效评估

Safety and long-term clinical efficacy of laparoscope-assisted and laparotomy total mesorectal excision treating rectal cancer

作者：应可明燕归如孙民昌陈菊华陈峥阚炳华白海涛王晓玉邵远党诚学

英文作者：

单位：723000陕西省汉中市中心医院肿瘤外科［应可明(为西安交通大学医学院第一附属医院肿瘤外科在读博士)、燕归如、孙民昌、陈峥、阚炳华、王晓玉、邵远］，病理科（陈菊华)；724400陕西省汉中市宁强县天津医院普外科（白海涛）；710060西安交通大学医学院第一附属医院肿瘤外科（党诚学）

英文单位：

关键词：直肠癌；全直肠系膜切除术；腹腔镜手术；开腹手术；安全性；总体生存率

英文关键词：

• 摘要：

• 【摘要】目的    比较腹腔镜与开腹直肠癌全直肠系膜切除术（TME）的安全性及远期临床疗效。方法    回顾性分析2009年1月至2013年8月陕西省汉中市中心医院肿瘤外科收治的261例直肠癌患者的临床资料。按照手术方式不同分为腹腔镜组（145例）和开腹组（116例）。腹腔镜组行腹腔镜直肠癌根治术；开腹组行开腹直肠癌根治术。比较2组安全性及术后远期疗效。结果    2组性别、年龄、分化程度、TME完整性、淋巴结转移、环周切缘阳性、术后局部复发方面比较差异均无统计学意义（均P＞0.05)。2组患者手术方式、pTNM分期、浸润深度、脉管癌栓、神经周围浸润、术后并发症、远处转移方面比较差异均有统计学意义（P=0.018、0.045、0.032、0.046、0.035、0.044、0.040）。腹腔镜组患者术后5年总体生存率明显高于开腹组患者（62.8%比51.6%，P=0.046）。结论    与开腹手术相比，腹腔镜直肠癌TME安全、可行，且远期疗效较好。

• 【Abstract】Objective    To compare the safety and long-term efficacy of laparoscope-assisted and laparotomy total mesorectal excision(TME) treating rectal cancer. Methods    Clinical data of 261 patients who had radical resection of rectal cancer in Hanzhong Central Hospital, Shaanxi Province from January 2009 to August 2013 were retrospectively analyzed. The patients were divided into laparoscopy group(145 cases) and laparotomy group(116 cases). Safety and long-term efficacy of the two surgical methods were analyzed. Results    There were no significant differences of gender, age, tumor differentiation, TME integrity, lymphatic metastasis, positive circumferential resection margin and local recurrence between groups(all P＞0.05). There were significant differences of operative procedure, pTNM stage, depth of invasion, vascular cancer thrombus, peripheral nerve infiltration, postoperative complication and distant metastasis between groups(P=0.018, 0.045, 0.032, 0.046, 0.035, 0.044, 0.040). The overall 5-year survival rate in laparoscopy group was significantly higher than that in laparotomy group(62.8% vs 51.6%, P=0.046). Conclusion    Laparoscopic TME is safe and feasible treating rectal cancer; it shows better long-term effect than laparotomy.