腹腔鏡腹部會陰切除手術，治療低位直腸癌四年經驗

Laparoscopic Abdominoperineal Resection for LowRectal Cancer 4 Years Experience

用腹腔鏡治療大腸直腸癌仍然有爭議性，所以本研究的目的是評估以腹腔鏡腹部會陰切除手術治療低位直腸癌的可行性。從2000年九月至2004年八月共有26例低位直腸癌病人接受腹部會陰切除手術。其中9例接受腹腔鏡手術，17例接受傳統手術，平均年齡分別爲61歲及62歲。腹腔鏡手術這組包括5例男性及4例女性。傳統手術這組包括5例男性及12例女性。腹腔鏡手術這組有3個併發症發生。傳統手術這組有13個併發症發生。平均手術時間腹腔鏡手術較久，分別爲205分鐘比185分鐘，平均出血量分別爲230cc比440cc，平均腸道恢復時間分別爲2.1天比4.6天，平均住院天數分別爲11天比14天。沒有死亡病例發生。平均追蹤22個月腹腔鏡手術這組有1病例發生遠處轉移。傳統手術這組有一例於術後3個月發生遠處轉移及局部複發。3例發生局部複發，因爲併發症，追蹤結果，手術時間及費用是可被接受的。所以，以腹腔鏡腹部會陰切除手術治療低位直腸癌是可行的。

The use of laparoscopic techniques in treating colorectal malignancy is still a controversial issue. The aim of this study was to evaluate whether laparoscopic abdominoperineal resection is feasible. From Sep. 2000 to Aug. 2004, there were 26 lower rectal cancer patients who received an abdominoperineal resection procedure,9 patients who received a laparoscopic procedure and 17 patients who received open procedures. Mean ages were 61 and 62 years for the laparoscopic and open procedures, respectively. Five cases of laparoscopic abdominoperineal resection and five cases of open abdominoperineal resection were males. Three complications occurred in the laparoscopic group and thirteen in the open group. Mean operative times were longer for the laparoscopic procedures(205 min for laparoscopic procedures vs. 185 min for open procedures; p < 0.05); mean blood loss (210 vs. 440 ml; p < 0.05), average bowel function return (2.1 vs. 4.6 days; P< 0.05), and hospital stay (11 vs. 14 days; P= not significant)were also evaluated. No mortality occurred. The mean follow-up period was 22 months, and one distant metastasis was found in the laparoscopic group, but one distant metastasis with local recurrence and three local recurrences occurred in the open group. We concluded that laparoscopic abdominoperineal resection is feasible with its acceptable complications, oncological results, operative times, and cost.