CAJ | 학술논문

目的比较腹腔镜下直肠癌根治术与传统开腹手术围手术期的疗效与安全性,评价腹腔镜下直肠癌根治术的可行性、安全性和肿瘤根治性.方法收集整理广州医学院第二附属医院胃肠外科开展腹腔镜下直肠癌根治术的44例临床资料,包括手术相关指标、术后恢复指标、肿瘤根治性指标、术中术后并发症等数据,进行统计学分析,并与同期53例传统开腹手术进行比较,评估两种手术方式围手术期疗效的差异性.结果腹腔镜组与开腹组的手术时间分别为( 260.45±67.46) min和(179.25±40.92) min,术中出血量分别为(125.20±61.80) mL和(198.60±131.24) mL,差异具有统计学意义(P＜0.05).术后肠道排气:腹腔镜组为(2.6±0.9)d,开腹组为(3.1±1.1)d；进食时间:腹腔镜组为(3.6±1.0)d,开腹组为(4.3±1.1)d；患者离床活动时间:腹腔镜组为(4.4±1.6)d,开腹组为(5.5±1.6)d,差异均有统计学意义(P＜0.05).且腹腔镜组的腹腔引流管及尿管保留时间均明显少于开腹组,差异具有统计学意义(P＜0.05).而手术中腹腔镜组输血患者4例,开腹组8例；术后腹腔镜组发生并发症5例,开腹组11例；术后住院天数分别为(15.34±6.62)d和(16.82±5.73)d,差异无统计学意义(P＞0.05).术后检查切除肠管长度、肿瘤距远端距离和淋巴结摘除个数等指标,2组标本差异均无统计学意义(P＞0.05).结论与开腹手术相比,腹腔镜下直肠癌根治术在围手术期具有微创、出血少、患者术后疼痛减轻、胃肠膀胱功能恢复快、下床早等优势,同时能减少术后并发症及缩短术后住院时间,但手术时间长于开腹组.虽然围手术期效果与开腹组无明显差异,但是远期疗效有待进一步随访追踪.
목적 비교복강경하직장암근치술여전통개복수술위수술기적료효여안전성,평개복강경하직장암근치술적가행성、안전성화종류근치성.방법 수집정리엄주의학원제이부속의원위장외과개전복강경하직장암근치술적44례림상자료,포괄수술상관지표、술후회복지표、종류근치성지표、술중술후병발증등수거,진행통계학분석,병여동기53례전통개복수술진행비교,평고량충수술방식위수술기료효적차이성.결과 복강경조여개복조적수술시간분별위( 260.45±67.46) min화(179.25±40.92) min,술중출혈량분별위(125.20±61.80) mL화(198.60±131.24) mL,차이구유통계학의의(P＜0.05).술후장도배기:복강경조위(2.6±0.9)d,개복조위(3.1±1.1)d；진식시간:복강경조위(3.6±1.0)d,개복조위(4.3±1.1)d；환자리상활동시간:복강경조위(4.4±1.6)d,개복조위(5.5±1.6)d,차이균유통계학의의(P＜0.05).차복강경조적복강인류관급뇨관보류시간균명현소우개복조,차이구유통계학의의(P＜0.05).이수술중복강경조수혈환자4례,개복조8례；술후복강경조발생병발증5례,개복조11례；술후주원천수분별위(15.34±6.62)d화(16.82±5.73)d,차이무통계학의의(P＞0.05).술후검사절제장관장도、종류거원단거리화림파결적제개수등지표,2조표본차이균무통계학의의(P＞0.05).결론 여개복수술상비,복강경하직장암근치술재위수술기구유미창、출혈소、환자술후동통감경、위장방광공능회복쾌、하상조등우세,동시능감소술후병발증급축단술후주원시간,단수술시간장우개복조.수연위수술기효과여개복조무명현차이,단시원기료효유대진일보수방추종.
Objective To compare the efficacy of the radical resection by laparoscopy versus open approach in perioperative period on the patients with rectal carcinoma,and investigate the feasibility,safety and oncological clearance of the laparoscopy.Methods The clinical data of 44 patients who underwent radical resection of rectal carcinoma by laparoscopy in our hospital were reviewed and compared with another 53patients who underwent an open approach in the same period.The surgery-related data,postoperative recovery status,tumor radical resection index,and postoperative complications by laparoscopy were analyzed by statistics,and compared with those by open approach,and evaluated the deference of too kinds of operation.Results This study showed a longer surgical time (260.45 ± 67.46) min vs ( 179.25 ± 40.92) min,P ＜0.05,a less intra-operative blood loss( 125.20 ±61.80) mL vs ( 198.02 ± 131.24) mL,P ＜0.05,in laparoscopic group compared with open approach.Meanwhile,it also showed an earlier recovery of bowel functions for discharge gas from anus,taking in food,and out-of-bed activity (4.34 ± 1.55) d vs(5.45 ± 1.55) d,P ＜0.05,in the laparoscopic group compared with open approach.There was no statistical difference of incidence of post-operative complications (5 cases vs 11 cases,P ＞0.05) between the two groups and the laparoscopic approach was also equal to the open approach as regard to post-operative stay (15.34 ±6.62) d vs (16.82±5.73) d,P ＞0.05,and demand of intra-operative blood transfusion (4 case vs 8 cases,P＞0.05 ).Conclusions Compared with open surgery,the radical resection of rectal carcinoma by laparoscopy has shown obvious advantages in smaller incision,less blood loss,less pain,earlier recovery of bowel and bladder functions,and earlier out-of-bed activity.And it is also possible by laparoscopy approach to decrease the post-operative complications and post-operative stay.Meanwhile,there is no significant deference on oncological clearance for laparoscopy compared with open approach during perioperative period,while the long term follow-up data is still needed to support the results.