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目的探讨手助腹腔镜手术(hand-assisted laparoscopic rectectomy,HALR)在中低位直肠癌根治术中的应用及临床效果。方法 230例中低位直肠癌患者依据手术方式分为腹腔镜组126例和开腹中低位直肠癌根治组104例(开腹组),记录患者围手术期参数及肿瘤学指标,并进行2组间比较。结果 2组手术过程均顺利,HALR组无中转开腹病例,HALR组手术时间[(125.7±27.6)min]与开腹组[(135.5±29.3)min]比较差异无统计学意义(P>0.05),HALR组切口长度[(7.1±1.3)cm]、术中出血量[(90.1±68.1)mL]、术后镇痛药物应用次数[(1.5±1.2)次]、排气时间[(2.6±0.3)d]、住院时间[(8.1±1.9)d]均低于开腹组[(21.5±4.2)cm、(155.3±76.4)mL、(3.3±1.5)次、(4.5±0.4)d、(14.3±2.1)d],2组比较差异均有统计学意义(P<0.05);腹腔镜组肿瘤直径[(3.0±1.8)cm]、淋巴结清扫个数[(18.5±7.1)个]、远端切缘长度[(2.1±1.2)cm]及术后病理分期与开腹组[肿瘤直径(2.8±1.3)cm、淋巴结清扫个数(15.8±6.5)个、远端切缘长度(2.1±1.0)cm]比较差异均无统计学意义(P>0.05);HALR组术后并发症发生率(17.5%)低于开腹组(26.0%)(P<0.05),术后30d病死率(1.6%)与开腹组(1.9%)比较差异无统计学意义(P>0.05)。结论 HALR应用于中低位直肠癌手术安全、可靠,并发症发生率低。
Objective To investigate the application and clinical effect of hand-assisted laparoscopic rectectomy (HALR) in the treatment of low and middle rectal cancer. Methods 230 cases of low rectal cancer patients were divided into laparoscopic group 126 cases and open lower rectum cancer group 104 cases (laparotomy group) according to the operation method. Perioperative parameters and oncological parameters were recorded and two groups Comparison between. Results The operation was successful in both groups. There was no laparotomy in the HALR group. The operative time in the HALR group [(125.7 ± 27.6) min vs 135.5 ± 29.3 min in the laparotomy group was not significantly different ), The length of incision in HALR group [(7.1 ± 1.3) cm], the amount of bleeding during operation [(90.1 ± 68.1) mL], the number of postoperative analgesic drugs [1.5 ± 1.2] ± 3.3 d) and length of hospital stay (8.1 ± 1.9 d) were significantly lower than those in the open group (21.5 ± 4.2 cm, 155.3 ± 76.4 mL, 3.3 ± 1.5, 4.5 ± 0.4 d, , (14.3 ± 2.1) d] respectively. There was significant difference between the two groups (P <0.05). The diameter of tumor in laparoscopic group was (3.0 ± 1.8) cm and the number of lymph node dissection was (18.5 ± 7.1) (2.1 ± 1.2) cm in distal end and pathological staging were compared with those in open group (tumor diameter 2.8 ± 1.3 cm, number of lymph node dissection 15.8 ± 6.5, length of distal incision 2.1 ± 1.0) cm] (P> 0.05). The incidence of postoperative complications in HALR group (17.5%) was lower than that in open group (26.0%) (P <0.05) There was no significant difference between the rate (1.6%) and the open group (1.9%) (P> 0.05). Conclusion The application of HALR in low and middle rectal cancer is safe, reliable and the complication rate is low.