中华胃肠外科杂志
中華胃腸外科雜誌
중화위장외과잡지
CHINESE JOURNAL OF GASTROINTESTINAL SURGERY
2014年
8期
791-795
,共5页
直肠肿瘤%根治性手术%腹腔镜%腹部手术史
直腸腫瘤%根治性手術%腹腔鏡%腹部手術史
직장종류%근치성수술%복강경%복부수술사
Rectal neoplasms%Radical resection%Laparoscopy%Previous abdominal surgery
目的：探讨既往腹部手术史对行腹腔镜辅助直肠癌根治术患者近期疗效的影响。方法回顾性分析2000年1月至2012年12月间由福建医科大学附属协和医院同一组医师连续实施的731例腹腔镜直肠癌根治术患者资料，其中有既往腹部手术史者（PAS组）121例，无既往腹部手术史者（NPAS组）610例，比较两组患者术中及术后情况。均值比较采用独立样本t检验，计数资料采用χ2检验或Fisher确切概率法。结果 PAS组与NPAS组淋巴结清扫数目分别为（18．8±7．9）枚和（18．9±8．2）枚，近切缘长度分别为（15．0±1．2） cm和（15．1±1．3） cm，远切缘长度分别为（3．9±1．4） cm和（3．8±1．5） cm，两组比较，差异均无统计学意义（均P＞0．05）。两组在手术时间、术中出血量、术中输血率、中转开腹率、术后肛门排气时间、进食流质时间、术后下床时间、术后住院时间、术后总并发症发生率等方面差异均无统计学意义（均P＞0．05）。但与NPAS组相比，PAS组术后肠梗阻发生率更高[5．0％（6/121）比1．5％（9/610），P＜0．05]。结论既往有腹部手术史的直肠癌患者行腹腔镜手术是安全可行的，但应注意术后肠梗阻的防治。
目的：探討既往腹部手術史對行腹腔鏡輔助直腸癌根治術患者近期療效的影響。方法迴顧性分析2000年1月至2012年12月間由福建醫科大學附屬協和醫院同一組醫師連續實施的731例腹腔鏡直腸癌根治術患者資料，其中有既往腹部手術史者（PAS組）121例，無既往腹部手術史者（NPAS組）610例，比較兩組患者術中及術後情況。均值比較採用獨立樣本t檢驗，計數資料採用χ2檢驗或Fisher確切概率法。結果 PAS組與NPAS組淋巴結清掃數目分彆為（18．8±7．9）枚和（18．9±8．2）枚，近切緣長度分彆為（15．0±1．2） cm和（15．1±1．3） cm，遠切緣長度分彆為（3．9±1．4） cm和（3．8±1．5） cm，兩組比較，差異均無統計學意義（均P＞0．05）。兩組在手術時間、術中齣血量、術中輸血率、中轉開腹率、術後肛門排氣時間、進食流質時間、術後下床時間、術後住院時間、術後總併髮癥髮生率等方麵差異均無統計學意義（均P＞0．05）。但與NPAS組相比，PAS組術後腸梗阻髮生率更高[5．0％（6/121）比1．5％（9/610），P＜0．05]。結論既往有腹部手術史的直腸癌患者行腹腔鏡手術是安全可行的，但應註意術後腸梗阻的防治。
목적：탐토기왕복부수술사대행복강경보조직장암근치술환자근기료효적영향。방법회고성분석2000년1월지2012년12월간유복건의과대학부속협화의원동일조의사련속실시적731례복강경직장암근치술환자자료，기중유기왕복부수술사자（PAS조）121례，무기왕복부수술사자（NPAS조）610례，비교량조환자술중급술후정황。균치비교채용독립양본t검험，계수자료채용χ2검험혹Fisher학절개솔법。결과 PAS조여NPAS조림파결청소수목분별위（18．8±7．9）매화（18．9±8．2）매，근절연장도분별위（15．0±1．2） cm화（15．1±1．3） cm，원절연장도분별위（3．9±1．4） cm화（3．8±1．5） cm，량조비교，차이균무통계학의의（균P＞0．05）。량조재수술시간、술중출혈량、술중수혈솔、중전개복솔、술후항문배기시간、진식류질시간、술후하상시간、술후주원시간、술후총병발증발생솔등방면차이균무통계학의의（균P＞0．05）。단여NPAS조상비，PAS조술후장경조발생솔경고[5．0％（6/121）비1．5％（9/610），P＜0．05]。결론기왕유복부수술사적직장암환자행복강경수술시안전가행적，단응주의술후장경조적방치。
Objective To investigate the impact of previous abdominal surgery on short-term outcomes in laparoscopy-assisted radical resection for rectal cancer. Methods Clinical data of 731 consecutive patients with rectal cancer who underwent laparoscopy-assisted radical resection in Union Hospital from January 2000 to December 2012 were retrospectively analyzed. Patients were classified as having previous abdominal surgery (PAS group, n=121) or not having previous abdominal surgery (NPAS group, n=610). Short-term outcomes including intraoperative and postoperative parameters were compared. Data were analyzed by independent sample t-test, Chi-square test or Fisher′ s exact probability. Results The mean number of lymph nodes dissected was 18.8 ±7.9 in PAS group and 18.9±8.2 in NPAS group, the length of proximal resection margin was (15.0±1.2) cm and (15.1± 1.3) cm respectively, the length of distal resection margin was (3.9 ±1.4) cm and (3.8 ±1.5) cm respectively. The differences between the two groups were not statistically significant (all P>0.05). Moreover, there were no significant differences in operative time, intraoperative blood loss, intraoperative blood transfusion, sphincter preservation operation rate, conversion rate, time to first flatus, time to liquid intake, postoperative ambulation time, postoperative hospital stay,-and postoperative complication rate between the two groups (all P>0.05). However, postoperative ileus was more frequent in PAS group than that in NPAS group (5.0%vs. 1.5%, P<0.05). Conclusions Laparoscopy-assisted radical resection is safe and feasible for patients with rectal cancer who experienced abdominal operations. But the prevention and treatment of postoperative ileus should be handled with caution.
