目的 探讨新疆地区肥胖直肠癌患者行腹腔镜直肠癌根治术的安全性、可行性及近期疗效.方法 回顾性分析2008年4月至2012年4月新疆医科大学附属肿瘤医院收治的205例行根治性手术的肥胖直肠癌患者的临床资料,按手术方式以及体质指数进行分组:腹腔镜组95例(Ⅰ度肥胖60例、Ⅱ度肥胖35例),开腹组110例(Ⅰ度肥胖65例、Ⅱ度肥胖45例).对比分析腹腔镜组和开腹组患者术中和术后情况及近期生存情况.患者采用邮件和电话等方式进行随访,随访截至2012年6月.计量资料比较采用t检验,计数资料比较采用x2检验或Fisher确切概率法.应用Kaplan-Meier法绘制生存曲线,采用Log-rank 检验分析生存情况.结果 Ⅰ度肥胖患者中腹腔镜组和开腹组的手术时间分别为(235±25) min和(241±23) min,淋巴结清扫数目分别为(19±6)枚和(19±6)枚,两组比较,差异无统计学意义(t=-1.416,0.100,P＞0.05)；术中出血量、肛门排气时间、术后住院时间、总并发症发生率分别为(195±77) ml、(1.7±0.6)d、(10.9±2.3)d、21.7％(13/60)和(393±170)ml、(3.8±1.1)d、(15.2±2.6)d、38.5％(25/65),两组比较,差异均有统计学意义(t=-8.229,-12.192,-12.002,x2=4.159,P＜0.05).Ⅱ度肥胖患者中腹腔镜组和开腹组的手术时间分别为(242 ±24) min和(250±23) min,淋巴结清扫数目分别为(17±5)枚和(18±7)枚,两组比较,差异无统计学意义(t=-1.556,-0.397,P＞0.05)；术中出血量、肛门排气时间、术后住院时间、总并发症发生率分别为(253±96)ml、(1.8±0.7)d、(11.2 ±2.5)d、17.1％ (6/35)和(443±180)nl、(4.2±1.2)d、(16.2±2.4)d、37.8％ (17/45),两组比较,差异均有统计学意义(t=-5.634,-11.205,-8.824,x2=4.092,P＜0.05).本组185例患者获得随访,中位随访时间为23个月,腹腔镜组与开腹组患者累积生存率比较,差异无统计学意义(x2=0.203,P＞0.05).结论 肥胖直肠癌患者行腹腔镜直肠癌根治术安全可行,能满足肿瘤根治的需要,不影响患者的生存时间.
目的 探討新疆地區肥胖直腸癌患者行腹腔鏡直腸癌根治術的安全性、可行性及近期療效.方法 迴顧性分析2008年4月至2012年4月新疆醫科大學附屬腫瘤醫院收治的205例行根治性手術的肥胖直腸癌患者的臨床資料,按手術方式以及體質指數進行分組:腹腔鏡組95例(Ⅰ度肥胖60例、Ⅱ度肥胖35例),開腹組110例(Ⅰ度肥胖65例、Ⅱ度肥胖45例).對比分析腹腔鏡組和開腹組患者術中和術後情況及近期生存情況.患者採用郵件和電話等方式進行隨訪,隨訪截至2012年6月.計量資料比較採用t檢驗,計數資料比較採用x2檢驗或Fisher確切概率法.應用Kaplan-Meier法繪製生存麯線,採用Log-rank 檢驗分析生存情況.結果 Ⅰ度肥胖患者中腹腔鏡組和開腹組的手術時間分彆為(235±25) min和(241±23) min,淋巴結清掃數目分彆為(19±6)枚和(19±6)枚,兩組比較,差異無統計學意義(t=-1.416,0.100,P＞0.05)；術中齣血量、肛門排氣時間、術後住院時間、總併髮癥髮生率分彆為(195±77) ml、(1.7±0.6)d、(10.9±2.3)d、21.7％(13/60)和(393±170)ml、(3.8±1.1)d、(15.2±2.6)d、38.5％(25/65),兩組比較,差異均有統計學意義(t=-8.229,-12.192,-12.002,x2=4.159,P＜0.05).Ⅱ度肥胖患者中腹腔鏡組和開腹組的手術時間分彆為(242 ±24) min和(250±23) min,淋巴結清掃數目分彆為(17±5)枚和(18±7)枚,兩組比較,差異無統計學意義(t=-1.556,-0.397,P＞0.05)；術中齣血量、肛門排氣時間、術後住院時間、總併髮癥髮生率分彆為(253±96)ml、(1.8±0.7)d、(11.2 ±2.5)d、17.1％ (6/35)和(443±180)nl、(4.2±1.2)d、(16.2±2.4)d、37.8％ (17/45),兩組比較,差異均有統計學意義(t=-5.634,-11.205,-8.824,x2=4.092,P＜0.05).本組185例患者穫得隨訪,中位隨訪時間為23箇月,腹腔鏡組與開腹組患者纍積生存率比較,差異無統計學意義(x2=0.203,P＞0.05).結論 肥胖直腸癌患者行腹腔鏡直腸癌根治術安全可行,能滿足腫瘤根治的需要,不影響患者的生存時間.
목적 탐토신강지구비반직장암환자행복강경직장암근치술적안전성、가행성급근기료효.방법 회고성분석2008년4월지2012년4월신강의과대학부속종류의원수치적205례행근치성수술적비반직장암환자적림상자료,안수술방식이급체질지수진행분조:복강경조95례(Ⅰ도비반60례、Ⅱ도비반35례),개복조110례(Ⅰ도비반65례、Ⅱ도비반45례).대비분석복강경조화개복조환자술중화술후정황급근기생존정황.환자채용유건화전화등방식진행수방,수방절지2012년6월.계량자료비교채용t검험,계수자료비교채용x2검험혹Fisher학절개솔법.응용Kaplan-Meier법회제생존곡선,채용Log-rank 검험분석생존정황.결과 Ⅰ도비반환자중복강경조화개복조적수술시간분별위(235±25) min화(241±23) min,림파결청소수목분별위(19±6)매화(19±6)매,량조비교,차이무통계학의의(t=-1.416,0.100,P＞0.05)；술중출혈량、항문배기시간、술후주원시간、총병발증발생솔분별위(195±77) ml、(1.7±0.6)d、(10.9±2.3)d、21.7％(13/60)화(393±170)ml、(3.8±1.1)d、(15.2±2.6)d、38.5％(25/65),량조비교,차이균유통계학의의(t=-8.229,-12.192,-12.002,x2=4.159,P＜0.05).Ⅱ도비반환자중복강경조화개복조적수술시간분별위(242 ±24) min화(250±23) min,림파결청소수목분별위(17±5)매화(18±7)매,량조비교,차이무통계학의의(t=-1.556,-0.397,P＞0.05)；술중출혈량、항문배기시간、술후주원시간、총병발증발생솔분별위(253±96)ml、(1.8±0.7)d、(11.2 ±2.5)d、17.1％ (6/35)화(443±180)nl、(4.2±1.2)d、(16.2±2.4)d、37.8％ (17/45),량조비교,차이균유통계학의의(t=-5.634,-11.205,-8.824,x2=4.092,P＜0.05).본조185례환자획득수방,중위수방시간위23개월,복강경조여개복조환자루적생존솔비교,차이무통계학의의(x2=0.203,P＞0.05).결론 비반직장암환자행복강경직장암근치술안전가행,능만족종류근치적수요,불영향환자적생존시간.
Objective To investigate the safety,feasibility and short-term efficacy of laparoscopic radical rectal resection for obese patients with rectal cancer.Methods The clinical data of 205 obese patients with rectal cancer who received radical resection at the Affiliated Tumor Hospital of Xinjiang Medical University from April 2008 to April 2012 were retrospectively analyzed.All patients were divided into 2 groups according to the surgical procedure and body mass index:95 patients were in the laparoscopic resection (LR) group (60 cases of Ⅰ degree obesity and 35 cases of Ⅱ degree obesity) and 110 patients were in the open resection (OR) group (65 cases of Ⅰ degree obesity and 45 cases of Ⅱ degree obesity).Paticnts were followed up till June 2012 by mail and phone call.The differences in intra-and postoperative situations and short-term survival rates of the 2 groups were compared using the t test,chi-square test or Fisher exact probability.The survival curve was drawn by KaplanMeier method,and the survival was analyzed using the Log-rank test.Results For patients with Ⅰ degree obesity,the mean operation time and number of lymph node dissected were (235 ±25)minutes and 19 ±6 in the LR group,and (241 ± 23)minutes and 19 ± 6 in the OR group,with no significant difference between the 2 groups (t =-1.416,0.100,P ＞ 0.05).The volume of blood loss,first flatus,duration of postoperative hospital stay,incidence of complications were (195 ±77) ml,(1.7 ± 0.6) days,(10.9 ± 2.3) days and 21.7％ (13/60) in the LR group,and (393 ± 170)ml,(3.8 ± 1.1) days,(15.2 ± 2.6) days,38.5％ (25/65) in the OR group,with significant differences between the 2 groups (t =-8.229,-12.192,-12.002,x2 =4.159,P ＜ 0.05).For patients with Ⅱ degree obesity,the mean operation time and number of lymph node dissected were (242 ± 24) minutes and 17±5 in the LR group,and (250 ± 23)minutes and 18 ± 7 in the OR group,with no siguificant difference between the 2 groups (t =-1.556,-0.397,P ＞ 0.05).The volume of blood loss,first flatus,duration of postoperative hospital stay,incidence of complications were (253 ± 96) ml,(1.8 ± 0.7) days,(11.2 ± 2.5) days and 17.1％(6/35) in the LR group,and (443 ±180)ml,(4.2±l.2)days,(16.2 ±2.4)days,37.8％(17/45) in the OR group,with significant differences between the 2 groups (t =-5.634,-11.205,-8.824,x2 =4.092,P ＜ 0.05).One hundred and eighty-five patients were followed up,with a median time of 23 months.There was no significant difference in the accumulative survival rate between the 2 groups (x2 =0.203,P ＞ 0.05).Conclusions Laparoscopic radical rectal resection is safe and feasible for obese patients.It could radically dissect tumors without influencing the survival time.
