关键词：结直肠肿瘤；外科手术；腹腔镜
摘要 目的 评估低位直肠癌的腹腔镜辅助下手术是否优 于传统的腹会阴联合切除术。方法 研究组在59例连续入院的患者 中选择24例进行腹腔镜辅助下腹会阴联合切除术，研究组与其他34例用传统方法手术的患者 (对照组)进行比较。结果 研究组和对照组分别随访30.1个月和28 . 3个月。研究组较对照组手术时间明显延长(P<0.001)，而术中出血量(P＝0.02) 和术后镇痛剂的需要量(P＝0.02)明显少于对照组，恢复正常饮食的时间(P＝0.04)和总住院时间(P＝0.02)明显短于对照组。两组的肿 瘤清除情况、并发症发生率、无瘤间期和生存率无明显差别。结论 腹腔镜辅助下腹会阴联合切除术与传统手术比较术后恢复较快，而肿瘤清除情况、并发症 、病死率、无瘤间期以及生存率无明显差别。
Laparoscopic assisted abdomino-perineal resection for low rectal adenocarcinoma
K.L.Leung，S.P.Y.Kwok* ，W.Y.Lu，W.C.S Meng，C.C.Chung，P.B.S. Lai，K.H.Kwong*
*From the Department of Surgery, the Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, New Territories, Hong Kong and the Department of Surgery , United Christian Hospital, Hong Kong*
*All correspondence to: Professor W.Y.Lau, Department of Surgery, The Chinese University of Hong Kong, Prince of Wales Hospital Shatin, New Territories, Ho ng Kong FAX NO:(852)26377974 Telephone NO:(852)26322623
Abstract Objective To find out whether laparoscopic assisted was better than open abdomino-perinea l resection for low rectal adenocarcinoma.Method Twenty-five (stu dy group) out of 59 consecutive patients who were considered su itable were selected for laparoscopic assisted abdomino-perineal resection. The y were compared with the other 34 patients operated by open method (control grou p).Results The median follow up time for the study and control groups were 30.1 and 28.3 months respectively. The operation time was significa ntly longer (t-test, P<0.001),while the operative blood loss (Mann-Whitn ey U test, P=0.02),the postoperative analgesic requirement (Mann Whitney U test,P=0.02),the time to r esume normal diet (Mann-Whitney U test, P=0.04) and the total hospital stay (Mann-Whitney U test,P=0.02) were significanty less in the study than in t he control group. The oncological clearance, the complication rate, the disease free interval and survival were comparable in the two groups. Conclusion Laparoscopic assisted abdomino-perineal resection allowed earlier postoperative recovery, with comparable oncological clearance, morbidity, mortality, disease free interval and survival.
Key words Colorectal neoplasms Surgical procedure Laparoscopic
Introduction
Since the successful introduction of laparoscopic cholecystectomy, laparoscopic a ssisted colorectal surgery has been widely attempted by enthusiastic surgeons. P romising early results were reported[1-4] . However, most of the series i nclud ed a heterogeneous group of benign and malignant diseases, as well as procedures of different magnitudes. The efficacy of a right hemicolectomy may not be the s a me as that of a left hemicolectomy, and most likely different from that of a col ostomy. Abdomino-perineal resection for cancer attracts separate consideration because of the concern of sacrificing the anal sphincter unnecessarily and the i ntrinsically high urogenital and perineal wound complication rates[5-7] . Fu rthermore,few studies have compared statistically the outcome of laparoscopic a n d conventional surgery in a cohort of patients. With increasing number of cases and the length of follow up time, interpretation of recurrence and survival data becomes more meaningful. This study aimed to find out whether laparoscopic assi sted resection was better than open abdomino-perineal resection for low rectal adenocarci noma. The data was prospectively collected in a time period when both approaches were used.
Patients and method
From January 1993 to January 1996,69 abdomino-perineal resections were performe d for patients with adenocarcinoma of low rectum. Ten patients were excluded fro m this study because they were considered not suitable for the laparoscopic assis ted resection, of which four patients had very bulky disease on investigations, three patients presented with recurrent or metachronous tumours, and three patie nts were planned for low anterior resection but failed to preserve the anal sphi ncter at operation.
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