中国微创外科杂志
中國微創外科雜誌
중국미창외과잡지
CHINESE JOURNAL OF MINIMALLY INVASIVE SURGERY
2014年
10期
896-899
,共4页
王立军%李瑞生%胡滨%王官成%叶红飞%段红艳
王立軍%李瑞生%鬍濱%王官成%葉紅飛%段紅豔
왕립군%리서생%호빈%왕관성%협홍비%단홍염
非气腹%无辅助切口%直肠癌%老年患者%腹腔镜%全直肠系膜切除术
非氣腹%無輔助切口%直腸癌%老年患者%腹腔鏡%全直腸繫膜切除術
비기복%무보조절구%직장암%노년환자%복강경%전직장계막절제술
Gasless%No auxiliary incision%Rectal cancer%Elderly patients%Laparoscope%Total mesorectal excision
目的：探讨非气腹完全腹腔镜直肠癌全直肠系膜切除术（ total mesorectal excision， TME）的临床价值。方法回顾比较我院2006年6月～2013年9月年龄＞66岁，因直肠癌接受非气腹完全腹腔镜直肠癌TME（n＝35）和气腹腹腔镜辅助直肠癌TME（ n＝33）的临床资料，比较2组手术时间、术中出血量、术后住院时间、术后并发症、清扫淋巴结数目、术后48 h引流量、肛门排气时间、进流质饮食时间、远切缘距病灶边缘距离。结果非气腹完全腹腔镜组手术时间（195．2±28．4） min，明显短于气腹腹腔镜辅助组（215．9±37．4）min（t＝2．559，P＝0．013）；术中出血量（125．3±39．8）ml，与气腹腹腔镜辅助组（130．1±45．0）ml无统计学差异（t＝-0．467，P＝0．642）；清扫淋巴结（11±4）枚，与气腹腹腔镜辅助组（12±5）枚无显著性差异（t＝-0．913，P＝0．364）；肛门排气时间（2．2±0．3）d，明显短于气腹腹腔镜辅助组（3．8±0．5）d（t＝-16．108，P＝0．000）；术后住院时间（5．2±1．3）d，明显短于气腹腹腔镜辅助组（8．1±2．2）d（t＝6．663，P＝0．000）；进流质饮食时间（3．2±0．7）d，明显短于气腹腹腔镜辅助组（4．6±0．4）d（t＝-10．044，P＝0．000）；远切缘距病灶边缘距离（4．2±0．7）cm，明显长于气腹腹腔镜辅助组（3．3±0．5）cm（t＝6．068，P＝0．000）；手术耗材费用（4920．10±665．6）元，明显少于气腹腹腔镜辅助组（7460．8±124．2）元（t＝-21．568，P＝0．000）。非气腹完全腹腔镜组无辅助切口，气腹腹腔镜辅助组术后切口并发症发生率36．4％（12／33），2组切口并发症有统计学差异（Fisher’s检验，P＝0．000）。结论非气腹完全腹腔镜直肠癌TME避免气腹对人体血流动力学的影响，无腹部辅助切口，更加美观，术后肠道恢复快，住院时间短，可达到腹腔镜辅助直肠癌手术同样的肿瘤根治效果，老年患者接受非气腹完全腹腔镜直肠癌TME是安全可行的。
目的：探討非氣腹完全腹腔鏡直腸癌全直腸繫膜切除術（ total mesorectal excision， TME）的臨床價值。方法迴顧比較我院2006年6月～2013年9月年齡＞66歲，因直腸癌接受非氣腹完全腹腔鏡直腸癌TME（n＝35）和氣腹腹腔鏡輔助直腸癌TME（ n＝33）的臨床資料，比較2組手術時間、術中齣血量、術後住院時間、術後併髮癥、清掃淋巴結數目、術後48 h引流量、肛門排氣時間、進流質飲食時間、遠切緣距病竈邊緣距離。結果非氣腹完全腹腔鏡組手術時間（195．2±28．4） min，明顯短于氣腹腹腔鏡輔助組（215．9±37．4）min（t＝2．559，P＝0．013）；術中齣血量（125．3±39．8）ml，與氣腹腹腔鏡輔助組（130．1±45．0）ml無統計學差異（t＝-0．467，P＝0．642）；清掃淋巴結（11±4）枚，與氣腹腹腔鏡輔助組（12±5）枚無顯著性差異（t＝-0．913，P＝0．364）；肛門排氣時間（2．2±0．3）d，明顯短于氣腹腹腔鏡輔助組（3．8±0．5）d（t＝-16．108，P＝0．000）；術後住院時間（5．2±1．3）d，明顯短于氣腹腹腔鏡輔助組（8．1±2．2）d（t＝6．663，P＝0．000）；進流質飲食時間（3．2±0．7）d，明顯短于氣腹腹腔鏡輔助組（4．6±0．4）d（t＝-10．044，P＝0．000）；遠切緣距病竈邊緣距離（4．2±0．7）cm，明顯長于氣腹腹腔鏡輔助組（3．3±0．5）cm（t＝6．068，P＝0．000）；手術耗材費用（4920．10±665．6）元，明顯少于氣腹腹腔鏡輔助組（7460．8±124．2）元（t＝-21．568，P＝0．000）。非氣腹完全腹腔鏡組無輔助切口，氣腹腹腔鏡輔助組術後切口併髮癥髮生率36．4％（12／33），2組切口併髮癥有統計學差異（Fisher’s檢驗，P＝0．000）。結論非氣腹完全腹腔鏡直腸癌TME避免氣腹對人體血流動力學的影響，無腹部輔助切口，更加美觀，術後腸道恢複快，住院時間短，可達到腹腔鏡輔助直腸癌手術同樣的腫瘤根治效果，老年患者接受非氣腹完全腹腔鏡直腸癌TME是安全可行的。
목적：탐토비기복완전복강경직장암전직장계막절제술（ total mesorectal excision， TME）적림상개치。방법회고비교아원2006년6월～2013년9월년령＞66세，인직장암접수비기복완전복강경직장암TME（n＝35）화기복복강경보조직장암TME（ n＝33）적림상자료，비교2조수술시간、술중출혈량、술후주원시간、술후병발증、청소림파결수목、술후48 h인류량、항문배기시간、진류질음식시간、원절연거병조변연거리。결과비기복완전복강경조수술시간（195．2±28．4） min，명현단우기복복강경보조조（215．9±37．4）min（t＝2．559，P＝0．013）；술중출혈량（125．3±39．8）ml，여기복복강경보조조（130．1±45．0）ml무통계학차이（t＝-0．467，P＝0．642）；청소림파결（11±4）매，여기복복강경보조조（12±5）매무현저성차이（t＝-0．913，P＝0．364）；항문배기시간（2．2±0．3）d，명현단우기복복강경보조조（3．8±0．5）d（t＝-16．108，P＝0．000）；술후주원시간（5．2±1．3）d，명현단우기복복강경보조조（8．1±2．2）d（t＝6．663，P＝0．000）；진류질음식시간（3．2±0．7）d，명현단우기복복강경보조조（4．6±0．4）d（t＝-10．044，P＝0．000）；원절연거병조변연거리（4．2±0．7）cm，명현장우기복복강경보조조（3．3±0．5）cm（t＝6．068，P＝0．000）；수술모재비용（4920．10±665．6）원，명현소우기복복강경보조조（7460．8±124．2）원（t＝-21．568，P＝0．000）。비기복완전복강경조무보조절구，기복복강경보조조술후절구병발증발생솔36．4％（12／33），2조절구병발증유통계학차이（Fisher’s검험，P＝0．000）。결론비기복완전복강경직장암TME피면기복대인체혈류동역학적영향，무복부보조절구，경가미관，술후장도회복쾌，주원시간단，가체도복강경보조직장암수술동양적종류근치효과，노년환자접수비기복완전복강경직장암TME시안전가행적。
Objective To evaluate the clinical value of gasless laparoscopic total mesorectal excision (TME). Methods Clinical data of patients (older than 66 years old) with rectal cancer in our hospital from June 2006 to June 2013, treated either by gasless laparoscopic TME ( n =35 ) or laparoscopic-assisted TME ( n =33 ) , were reviewed retrospectively.The operation time, intraoperative blood loss, postoperative hospital stay, postoperative complications, number of lymph node removed, drainage volume 48 hours after surgery, time to flatus, time to liquid diet, distance from distal cutting edge to lesion, and operative expenditure were compared between the two groups. Results The operation time was significantly shorter in the gasless group [(195.2 ±28.4) min] than that in the laparoscopic-assisted group [(215.9 ±37.4) min,t=2.559,P=0.013].There were no significant differences in blood loss [(125.3 ±39.8) ml vs.(130.1 ±45.0) ml, t=-0.467, P=0.642] and number of lymph nodes [(11 ±4) vs. (12 ±5), t=-0.913, P=0.364] between the gasless group and the laparoscopic-assisted group.The time to flatus was significantly shorter in the gasless group [(2.2 ±0.3) d] than that in the laparoscopic-assisted group [(3.8 ±0.5) d, t=-16.108, P=0.000].The length of postoperative hospital stay was significantly shorter in the gasless group [(5.2 ±1.3) d] than that in the laparoscopic-assisted group [(8.1 ±2.2) d, t=6.663, P=0.000].The time to liquid diet was significantly shorter in the gasless group [(3.2 ±0.7) d] than that in the laparoscopic-assisted group [(4.6 ±0.4) d, t=-10.044, P=0.000].The distance from distal cutting edge to the lesion was significantly longer in the gasless group [(4.2 ±0.7) cm] than that in the laparoscopic-assisted group [(3.3 ±0.5) cm, t=6.068, P=0.000].The operation expenditure was significantly less in the gasless group [(4920.10 ± 665.6) yuan] than that in the laparoscopic-assisted group [(7460.8 ±124.2) yuan, t=-21.568, P=0.000].No auxiliary incision was needed for the gasless group, whereas the incidence of incision-related complications was 36.4%( 12/33 ) for the laparoscopic-assisted group, with significant difference (Fisher’s test,P=0.000). Conclusions Gasless laparoscopic TME has advantages of no auxiliary incision, good cosmetic results, fast postoperative bowel recovery, and short hospitalization.The procedure is comparable of laparoscopic-assisted surgery in clinical effects, being a safe and feasible option for elderly patients.
