Laparoscopic Assisted Compared With Open Resection Of Rectal Carcinoma Clinical Analysis

Rectal cancer is one of the most common cancers of digestive tract. In recent years, with the development of economy in China and people’s diet structure and living habits changing, the incidence and mortality of rectal cancer in China rises sharply. Comprehensive treatment of rectal cancer has made great progress, but the operation is still the best method. Compared with the traditional open operation, laparoscopic anterior resection for rectal cancer has obvious advantages. With the experience of operation technique of laparoscopic surgeons accumulating and summarizing, laparoscopic anterior resection for rectal cancer has been popularized and achieved significant curative effect. But in 2010, in order to standardize the treatment of colorectal cancer, China’s Ministry of health has made a "standard" for the diagnosis and treatment of colorectal cancer with laparoscopic operation for rectal cancer,which is not recommended. In 2014 American National Comprehensive Cancer Network guidelines for clinical research of laparoscopic rectal operation only. In these days promoting the standardization of treatment, laparoscopic anterior resection for rectal cancer is still controversial, facing a variety of objections.Aim: In this study, the curative effects of laparoscopic assisted and open anterior resection of the rectum are compared. And the feasibility and safety of laparoscopic operation in the treatment of rectal cancer are discussed.Method: After analyzing some patients with rectal cancer whose cancer lesions are 8-15 cm away from the anus during 2008-2014 in Dalian Central Hospital, and analyzing 50 underwent laparoscopic assistance and 43 open colorectal resection, Compare the data of the two groups, which includes time, intraoperative blood loss, the number of lymph node cleaning, the postoperative analgesic requirements, postoperative anal exhaust t ime, postoperative eating time, postoperative hospital stay and postoperative complications : voiding dysfunction, infection of incision, lung infection and anastomotic fistula, intestinal obstruction, etc. It used the SPSS 17. 0 statistical software for statistical analysis. Among them, the count data to the number of cases and the percentage(%), said by chi-square test and Fisher exact rate test; Measurement data to mean ± standard deviation( x ±s) said, using the t test. Results: Laparoscopic group operation time was 177.0 ± 20.6 min, laparotomy group operation time was 172.1 ± 16.0 min, comparing their time is of no sense(P > 0.05, see table 2);Bleeding amount of laparoscopic group was 117.0 ± 10.3 ml, bleeding amount of laparotomy group was 340.6 ± 19.0 ml, blood loss of the patients compared in these two groups is of statistical sense(P < 0.05, see table 2);The lymph node cleaning the laparoscopic group number was 15.2 ± 1.2; Open the lymph node set number was 15.1 ± 1.3, two groups of patients on the number of lymph node cleaning is of no statistical difference(P > 0.05, see table 2); Use of morphine in postoperative pain relievers, laparoscopic assisted group was 30.0 ± 7.3 mg, laparotomy group was 47.7 ± 10.2 mg, postoperative morphine consumption laparotomy group was obviously higher than that of laparoscopic assisted group, with statistical significance(P < 0.05, see table 3); Laparoscopic group was 2.5 ± 0.7 d postoperative anal exhaust time, open group was 3.7 ± 0.7 d postoperative anal exhaust time, two groups of patients in postoperative exhaust time is statistically significant(P < 0.05, see table 3); Laparoscopic group began eating time was 3.5 ± 0.7 d, laparotomy group began eating time was 4.7 ± 0.8 d, two groups of patients in the postoperative time of food intake is statistically significant(P < 0.05, see table 3); Laparoscopic group of postoperative hospital stay was 10.9 ± 1.4 d, postoperative hospital stay was 12.4 ± 1.3 d laparotomy group, two groups of patients in postoperative hospital stay compared statistically significant(P < 0.05, see table 3); Micturition function comparison(see table 4), Laparoscopic assisted group micturition function grade I 6 cases, Ⅱ level 39 cases, Ⅲ level 3 cases and Ⅳ level 2 cases, postoperative micturition function disorder(Ⅲ + Ⅳ) in 5 cases(10%). Laparotomy group micturition function grade I 7 cases, Ⅱ level 25 cases, Ⅲ level 6 cases and Ⅳ level 5 cases, postoperative micturition function disorder(Ⅲ + Ⅳ) in 11 cases(25.6%), two groups of patients in voiding dysfunction comparison was statistically significant(P < 0.05, see table 5);Laparoscopic group of incision infection in 0 case, pulmonary infection in 1 cases, 3 cases were anastomotic fistula, intestinal obstruction in 2 cases. Open group of incision infection occurred in 4 cases, pulmonary infection in 1 case, 3 cases of anastomotic fistula, 4 cases were intestinal obstruction. Compared two groups of patients in the postoperative complications, incision infection and intestinal obstruction retention was statistically significant(P < 0.05, see table 5); Comparison on pulmonary infection and anastomotic fistula(P < 0.05, see table 5) there is no statistical significance.Conclusion: In the high radical resection of rectal cancer, laparoscopic assisted technique is safe and feasible, and is worthy of further promotion.