腹腔镜辅助与手助腹腔镜在结直肠癌根治术中的应用及体质量指数对手术结局的影响

发布时间：2018-06-12 00:13

本文选题：手助腹腔镜手术 + 腹腔镜辅助手术　；参考：《重庆医学》2017年17期

【摘要】：目的比较腹腔镜辅助手术(LAS)与手助腹腔镜手术(HALS)在结直肠癌(CRC)根治术中的应用价值及短期治疗效果,以及体质量指数(BMI)对手术结局的影响。方法对近5年内在邢台市人民医院接受手术治疗的120例CRC患者病例资料进行回顾分析,按手术术式的不同分别定义为LAS组(58例)与HALS组(62例),另以BMI指数为分组依据分为非超重组(53例)与超重组(67例),统计患者的一般资料、手术相关指标(包括手术时间、麻醉时间、ASA分级、术中出血量、淋巴结清扫个数、刀口长度、Trocar使用数量及中转开腹等)、术后恢复指标(包括术后进食时间、留置导尿时间及住院时间)、术后并发症及随访情况。结果 HALS组的手术时间与麻醉时间较LAS组均显著缩短(P0.01),非超重组中接受HALS患者的手术时间为(83.52±18.14)min,接受LAS患者为(90.03±27.54)min,二者比较差异无统计学意义(P0.05);超重组中接受HALS患者为(91.37±15.81)min,接受LAS患者为(135.02±22.59)min,二者比较差异有统计学意义(P0.01);HALS组患者术中出血量与Trocar使用数量较LAS组均明显减少(P0.01);HALS组未有中转开腹病例,LAS组中转开腹2例;在超重组中接受LAS治疗患者的手术时间更长(P0.01);LAS组与HALS组的术后进食时间、术后留置导尿时间及住院时间组间比较,差异均无统计学意义(P0.05);LAS组与HALS组的术后镇痛、感染、吻合口瘘及住院期间再手术等指标比较,差异无统计学意义(P0.05);随访期间LAS组发生切口疝、复发转移与死亡病例各1例,HALS组发生复发转移1例。结论 LAS与HALS两种术式均可作为CRC的常规术式,但HALS较LAS在缩短手术时间方面更具优势,肥胖CRC患者应优先选用HALS术式。
[Abstract]:Objective to compare the application value of LAS-assisted laparoscopic surgery (LAS) and hand-assisted laparoscopic surgery (HALS) in radical resection of colorectal carcinoma and the effect of BMII on the outcome of operation. Methods the data of 120 patients with CRC who received surgical treatment in Xingtai people's Hospital in recent 5 years were retrospectively analyzed. According to the different operative methods, 58 cases of Las group and 62 cases of Hals group were divided into two groups: the BMI index was divided into 53 cases of non-superrecombination group and 67 cases of hyperrecombination group. The general data of the patients and the operative time (including the time of operation) were analyzed. Anaesthesia time and ASA grade, intraoperative bleeding volume, number of lymph node dissection, length of knife edge and Trocar usage and conversion to laparotomy, postoperative recovery index (including postoperative feeding time, indwelling catheterization time and hospitalization time), postoperative complications and follow-up. Results the time of operation and anesthesia in Hals group was significantly shorter than that in Las group. The operative time of patients receiving Hals in non-superrecombination group was 83.52 卤18.14 min and that in Las group was 90.03 卤27.54 min. There was no significant difference between the two groups. For 91.37 卤15.81 min and 135.02 卤22.59 min in patients receiving Las, there was a significant difference between the two groups. The amount of intraoperative bleeding and the amount of Trocar in Hals group were significantly lower than those in Las group. The postoperative feeding time, postoperative catheterization time and hospitalization time of patients receiving Las in superrecombination group were longer than those in the control group and Hals group. There was no significant difference in postoperative analgesia and infection between the two groups. There was no significant difference in anastomotic fistula and reoperation during hospitalization, while incisional hernia occurred in Las group during follow-up, and recurrence and metastasis occurred in 1 case in Hals group and 1 case in Hals group during follow-up. Conclusion Las and Hals can be used as routine operation for CRC, but Hals is superior to Las in shortening operative time. Hals should be preferred in obese CRC patients.
【作者单位】：河北省邢台市人民医院普外科;邢台医学高等专科学技第二附属医院普外科;河北省邢台市人民医院CTMR室;
【分类号】：R735.34

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