| Objective:In this study,a prospective randomized controlled study was conducted to compare the safety,radical,short-term and long-term outcomes of laparoscopic radical resection of rectal cancer with those of laparoscopic radical resection of rectal cancer in our hospital(Zhangj iagang First People's Hospital),so as to provide more information for the application of laparoscopy in radical resection of rectal cancer.Clinical evidence.Methods:1 Subjects and GroupsFrom January 2014 to October 2018,patients with rectal cancer diagnosed in the First People's Hospital of Zhangjiagang City who need surgical treatment were divided into laparoscopic group and open group.2 Evaluating IndicatorRelevant data of pathological specimens,intraoperative indicators,postoperative indicators,occurrence of complications,post-operative stress response and mortality within 30 days after surgery;in addition,follow-up was conducted to collect the tumor-free survival rate and recurrence and metastasis rate of patients after discharge as long-term efficacy evaluation indicators.To analyze and compare the above indicators between laparoscopic and open radical resection of rectal cancer.Results:1 Basic SituationA total of 158 patients with rectal cancer were included in this study.76 patients underwent laparoscopic surgery and 82 patients underwent laparoscopic surgery.Among them,2 patients underwent laparoscopic surgery because of the need to switch to laparotomy during laparoscopic surgery,so the laparoscopic group consisted of 80 patients.There were no significant differences in age,sex,Karnofsky score,BMI,medical complications,Dukes stage,TNM stage,size,location and differentiation between the two groups(P>0.05).2 Comparative display of pathological specimensThe length of intestinal resection in laparoscopic group was 16.81±3.28 cm,which was slightly smaller than that in open group(17.23±3.95 cm),but there was no significant difference in the length of intestinal resection between the two groups(P>0.05);there was no significant difference in the proximal incision margin between laparoscopic group(9.36±2.51 cm)and open group(10.08±2.37 cm)(P>0.05);however,the distal incision margin in laparoscopic group was 3.32±1.01 cm).The number of lymph nodes dissected in laparoscopic group was 16.42±3.44,which was significantly less than that in open group(18.79±2.87,P<0.05).3 Comparisons of operation time showed that:The operation time of laparoscopic group(169.1±22.8 min)was significantly shorter than that of open group(184.5±39.6)(P<0.05),and the bleeding volume of laparoscopic group(101.16±4.45 ml)was significantly less than that of open group(241.79±9.33)(P<0.05).4 Postoperative recovery indicators showed that the time to start exhaust in laparoscopic group was 3.01 ±0.87 days),significantly shorter than that in open group(4.72± 1.01 days,P<0.05);meanwhile,the time to start eating in laparoscopic group was 3.52± 1.07 days,significantly shorter than that in open group(5.45 ± 1.34 days,P<0.05);and the time of indwelling urinary catheter in laparoscopic group was significantly shorter than that in open group(2.85 ±0.67 days vs 4.01).In addition,the time of drainage tube removal in laparoscopic patients was significantly shorter than that in open group(6.21 ±2.01 D vs 8.02±2.33 d,P<0.05).The hospital stay in laparoscopic group was 9.54±3.18 days,while that in open group was 12.39±3.86.The hospital stay in laparoscopic group was significantly shorter than that in open group(P<0.05).5 Comparisons of postoperative complications showed that there was no significant difference in the incidence of abdominal bleeding and anastomotic leakage between the two groups(P>0.05),but the incidence of urinary dysfunction in the laparoscopic group was significantly higher than that in the laparoscopic group(P<0.05);in addition,incision infection,abdominal pelvic infection and pulmonary infection in the laparoscopic group were significantly higher than those in the laparoscopic group.The incidence of posterior intestinal obstruction was significantly lower than that of open group.6 The results of post-operative stress response evaluation showed that the level of CRP(mmol/l)in laparoscopic group was significantly lower than that in open group(29.34±4.87vs 4 8.77±5.66),P<0.05);meanwhile,the level of IL-6(?mol/l)in laparoscopic group was also significantly lower than that in open group(31.45±5.18 vs 56.79±4.86,P<0.05),and the level of TNF-a(?mol/l)in laparoscopic group was also significantly lower than that in open group(60.33±6.82vs105.39±8.In the analysis of T lymphocyte subsets,the percentage of CD4+lymphocyte(%)in laparoscopic group was significantly higher than that in laparoscopic group(34.76±6.1 lvs52.68±5.37,P<0.05),and the ratio of CD4+/CD8+in laparoscopic group was also significantly lower than that in open group(1.35±0.89vs2.17±0.75,P<0.05).7 Long-term efficacy comparison showed that during follow-up,the tumor-free survival rate of laparoscopic group was 68.00%,and that of open group was 68.57%;11 patients(14.67%)had recurrence and metastasis in laparoscopic group,10 patients(14.29%)had recurrence and metastasis in open group,13 patients(17.33%)died in laparoscopic group,12 patients(17.14%)died in open group,and there was no recurrence and metastasis in laparoscopic group.There was no significant difference in survival rate,recurrence and metastasis rate and mortality rate(all P>0.05).Conclusions:1 There was no significant difference between laparoscopic group and laparotomy group in the integrity of tumor resection,but the number of lymph nodes dissected in laparoscopic group was less than that in laparotomy group.2 In terms of operation safety,the laparoscopic group has a significantly shorter operation time than the open group,while the blood loss in the laparoscopic group is significantly less than that in the open group,and the postoperative complications in the laparoscopic group are also less than that in the open group.3 In terms of postoperative recovery,the laparoscopic group was due to the laparotomy group.In addition,the post-operative stress response of the laparoscopic group was also significantly lower than that of the laparotomy group.4 In the long-term efficacy,there was no significant difference between laparoscopic group and open group in tumor-free survival rate,recurrence and metastasis rate and mortality. |
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