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目的:探讨开腹与腹腔镜全系膜切除术(TME)治疗直肠癌的疗效及安全性。方法:选择本院收治的直肠癌患者118例,随机分为对照组和观察组,各为59例。对照组行开腹直肠全系膜切除术,观察组行腔镜直肠全系膜切除根治术。比较两组术中效果、淋巴结清扫效果、术后肠道功能恢复、手术风险和随访结果。结果:两组手术时间和淋巴结清扫数目无显著差异(P>0.05);观察组切口长度和术中出血量显著少于对照组(P<0.05),肛门排气、肠胃功能恢复和总住院时间均显著短于对照组(P<0.05);观察组总并发症率为5.08%,显著低于对照16.95%(P<0.05);观察组保肛率达到81.36%,显著高于对照组66.10%(P<0.05);两组2年复发率和转移率间差异无统计学意义(P>0.05)。结论:腹腔镜直肠癌TME创伤小,根治率高,术后恢复快,并发症少,远期疗效与开腹手术相近,综合疗效优于开腹根治术。
Objective: To investigate the efficacy and safety of open laparoscopic and total mesorectal excision (TME) in the treatment of rectal cancer. Methods: A total of 118 patients with rectal cancer admitted to our hospital were randomly divided into control group and observation group, with 59 cases in each. The control group underwent open radical mesorectal excision. The observation group underwent total mesorectal excision. The effects of operation, lymph node dissection, postoperative intestinal function recovery, operative risk and follow-up results were compared between the two groups. Results: There was no significant difference in operative time and number of lymph node dissection between the two groups (P> 0.05). The incision length and intraoperative blood loss in the observation group were significantly less than those in the control group (P <0.05), anal exhaust, gastrointestinal function recovery and total hospital stay (P <0.05). The total complication rate in the observation group was 5.08%, which was significantly lower than that in the control group (16.95%, P <0.05). The anal sphincter preservation rate in the observation group was 81.36%, significantly higher than that in the control group (66.10% (P <0.05). There was no significant difference in recurrence rate and metastasis rate between the two groups in 2 years (P> 0.05). Conclusion: TME of laparoscopic rectal cancer has the advantages of less trauma, high cure rate, quick recovery after operation, less complications and long-term curative effect compared with laparotomy. The comprehensive curative effect is better than laparotomy.