Abstract:

Clinical comparison of short-term treatment outcomes between two-port and conventional laparoscopic anterior resection for rectal cancer        ZHANG Hong, LING Yun-zhi, CONG Jin-chun,et al.Department of Colorectal Surgery, Shengjing Hospital, China Medical University, Shenyang 110004, China
Corresponding author: ZHANG Hong, E-mail: haojiubujian1203@sina.cn
Abstract    Objective    To explore and analyze the safety and feasiblity of two-port laparoscopic anterior resection for rectal cancer. Methods    The clinical data of 38 patients underwent two-port laparoscopic surgery and 40 patients underwent conventional laparoscopic surgery for treatment of rectal cancer in Shengjing Hospital, China Medical University between June 2012 and December 2014 were analyzed retrospectively. The blood loss, duration of procedure, intraoperative complication, conversion to open surgery, length of abdominal incision, distal resection margin, rates of circumferential resection margin involvement, number of lumph nodes havested, postoperative TNM stage, reoperation, duration before first flatus, postoperative complication, postoperative pain score, systemic stress responses and length of postoperative hospital stay of the two groups were analyzed. Results    No significant difference was observed in blood loss, operative time, conversion rate, distal resection margin, rates of circumferential resection margin involvement, number of lumph nodes havested, postoperative TNM stage, duration before first flatus, intraoperative and postoperative complication, and length of postoperative hospital stay between the two groups（P>0.05）. Two-port group had shorter length of abdominal incisions ［（5.1±0.5）cm vs.（8.4±0.9）cm, P<0.05］. Postoperative pain scores were lower in the two-port group at 24h ［（4.1±1.3）vs.（5.0±1.6）, P<0.05］, 48h ［（2.8±1.1）vs. (4.0±1.4), P<0.05］ and 72h ［（1.9±1.1） vs.（2.7±1.2）, P<0.05］ . The level of C-reactive protein ［13.2(1.3～111.7)mg/L vs. 22.2(6.9～135.0)mg/L, P<0.05］,interleukin-6［(20.8±9.4）ng/L vs.（26.6±13.6）ng/L, or 20.5(6.1～45.5) mg/L vs. 30.8(6.3～60.2)mg/L, P<0.05］, and cortisol［（619.4±185.4）nmol/L vs.（754.6±164.1）nmol/L,or 499.7(300.8～935.7) nmol/L vs. 777.2(533.7～1008.5)nmol/L, P<0.05］ in the two-port group were lower than those in conventional laparoscopic surgery group at 1 day postoperatively. The level of C-reactive protein［（30.1±27.4）mg/L vs.（64.1±49.1）mg/L,or 20.8(1.4～110.1) vs. 68.7(9.7～176.6)mg/L, P<0.05］ and cortisol［566.7(438.6～1005.2)nmol/L vs.666.2(100.5～1099.8)nmol/L,P<0.05］ in the two-port group was lower than that in conventional laparoscopic surgery group at 2 day postoperatively. The level of C-reactive protein［12.5(1.5～111.1)mg/L vs. 23.4(9.7～167.8)mg/L, P<0.05］ was lower than that in conventional laparoscopic surgery group at 3 day postoperatively. Conclusion  Two-port laparoscopic anterior resection for rectal cancer is safe and feasible. It is not worse than conventional laparoscopic surgery in terms of short-term perioperative and oncological outcomes and has the benefits of less postoperative pain and less systemic stress response.

Key words: rectal carcinoma, laparoscopy, reduced-port laparoscopic surgery, anterior resection for rectal cancer

摘要：

目的    探讨改良两孔法腹腔镜直肠癌前切除术的安全性和可行性。方法    回顾性分析2012年6月至2014年12月中国医科大学附属盛京医院同一手术组的38例改良两孔法（两孔组）和40例常规五孔法（五孔组）腹腔镜直肠癌前切除术的临床资料，对比两组术中失血量、手术时间、术中并发症、中转开腹率、腹部切口总长度、标本远端切缘长度、环周切缘阳性率、淋巴结清扫数目、术后病理学TNM分期、再次手术率、首次排气时间、术后并发症、术后疼痛情况、术后应激情况及术后住院天数等短期临床疗效。结果    两组病人术中失血量、手术时间、中转开腹率、标本远端切缘长度、环周切缘阳性率、淋巴结清扫数目、术后病理学TNM分期、首次排气时间、术中及术后并发症及术后住院天数差异均无统计学意义（P>0.05）。两孔组腹部切口总长度短于五孔组［（5.1±0.5）cm vs. （8.4±0.9）cm，P<0.05］，术后24 h［（4.1±1.3）分vs.（5.0±1.6）分，P<0.05］、术后48 h ［（2.8±1.1）分vs. （4.0±1.4）分，P<0.05］和术后72 h ［（1.9±1.1）分 vs.（2.7±1.2）分，P<0.05］的疼痛评分低于五孔组。两孔组术后第1天的C-反应蛋白［13.2（1.3~111.7）mg/L vs.22.2（6.9~135.0）mg/L，P<0.05］、白细胞介素-6［20.8±9.4）ng/L vs.（26.6±13.6）ng/L或20.5（6.1~45.5）ng/L vs. 30.8（6.3~60.2）ng/L，P<0.05］及皮质醇［（619.4±185.4）nmol/L vs.（754.6±164.1）nmol/L或499.7（300.8~935.7）nmol/L vs. 777.2（533.7~1008.5）nmol/L，P<0.05］，术后第2天的C反应蛋白［（30.1±27.4）mg/L vs.（64.1±49.1）mg/L或20.8（1.4~110.1）mg/L vs. 68.7（9.7~176.6）mg/L，P<0.05］，皮质醇［566.7（438.6~1005.2）nmol/L vs. 666.2（100.5~1099.8）nmol/L，P<0.05］，术后第3天C-反应蛋白［12.5（1.5~111.1）mg/L vs. 23.4（9.7~167.8）mg/L，P<0.05］水平低于五孔组。结论    改良两孔腹腔镜直肠癌前切除术安全可行，其短期术后结局指标和肿瘤根治性不劣于常规五孔法腹腔镜手术，同时具有术后疼痛轻，应激小的优点，值得进一步推广应用。

关键词: 直肠肿瘤, 腹腔镜, 减孔手术, 直肠前切除术