腹腔镜与开腹全结肠切除术治疗家族性腺瘤性息肉病的疗效比较

发布时间：2018-12-11 08:22

【摘要】：目的：随着腹腔镜技术的不断成熟,临床经验的不断增加,手术器械的不断进步,腹腔镜手术相对于传统开腹手术创伤小、恢复快的优势逐渐得到认可,并使腹腔镜手术的应用不断推广。本研究通过比较腹腔镜下全结肠切除术与传统开腹手术治疗家族性腺瘤性息肉病的临床疗效,探讨前者的安全性、可行性和临床应用价值。方法：回顾性分析我院2009年1月至2014年10月37例行全结肠切除术的FAP患者的临床资料,其中腹腔镜手术者19例,开腹手术组18例。通过SPSS 21.0统计学软件处理患者术前、术中、术后的相关资料,分析腹腔镜手术相对于传统开腹手术的临床效果,并结合文献对此进行讨论和评价。结果：腹腔镜组和传统开腹组均顺利完成手术,腹腔镜组无患者中转开腹。在性别、年龄、体质指数、FAP家族史、息肉恶变、术前贫血、ASA分级无明显差异情况下(P值0.05),腹腔镜组相较传统开腹组切口长度明显缩短(5.8±0.7cm VS 19.9±1.6 cm),术中出血量明显减少(137.9±30.1 ml VS 188.9±53.8 ml),两组差异有显著统计学意义(P值0.01)。手术时间腹腔镜组相对于传统开腹组有所延长(277.8±35.9 min VS 237.8±26.9 min),且两组差异有显著统计学意义(P值0.01)。而术中输血数两组间差异无统计学意义(P值0.05)。术后恢复中腹腔镜组在应用镇痛药物、胃肠功能恢复时间、尿管拔除时间、腹腔3d引流量、术后进流质饮食等方面明显较传统开腹组有优势(P值0.05),特别是在下床活动时间、术后进半流质时间、术后住院日方面更为突出(P值0.01)。腹腔镜组和传统开腹组均有吻合口瘘等并发症出现,两组间术后并发症发生率差异无统计学意义(21.1% VS 27.8% P值0.05)。两组在随访时间和随访例数无差异情况下,复发转移及病死情况亦无无明显差异(P值0.05)。结论：腹腔镜下行全结肠切除术与传统开腹手术相比具有创伤小、术中出血少、术后疼痛轻、术后恢复快、住院日短等优点,而手术并发症、复发转移及病死情况两组无明显差异,其治疗家族性腺瘤性息肉病是安全的可行的,具有较高的临床应用价值。
[Abstract]:Objective: with the development of laparoscopic technique, the increasing of clinical experience and the improvement of surgical instruments, the advantages of laparoscopic surgery with less trauma and faster recovery than traditional open surgery have been recognized. The application of laparoscopic surgery has been popularized. The purpose of this study was to compare the clinical efficacy of laparoscopic total colectomy and traditional open surgery in the treatment of familial adenomatous polyposis, and to explore the safety, feasibility and clinical value of the former. Methods: the clinical data of 37 patients with FAP undergoing total colectomy in our hospital from January 2009 to October 2014 were analyzed retrospectively. There were 19 cases of laparoscopic surgery and 18 cases of open operation group. The clinical results of laparoscopic surgery compared with traditional open surgery were analyzed by SPSS 21. 0 statistical software, and the results were discussed and evaluated in combination with the literature. Results: the laparoscopic group and the traditional open group successfully completed the operation, no patients in the laparoscopic group were converted to open surgery. There were no significant differences in sex, age, body mass index, FAP family history, polyp malignancy, preoperative anemia and ASA grade (P < 0. 05). The length of incision in the laparoscopic group was significantly shorter than that in the traditional open group (5.8 卤0.7cm VS 19.9 卤1.6 cm),). The amount of bleeding was significantly decreased (137.9 卤30.1 ml VS, 188.9 卤53.8 ml),). There was significant difference between the two groups (P 0.01). The operative time in the laparoscopic group was significantly longer than that in the traditional open group (277.8 卤35.9 min VS 237.8 卤26.9 min), P < 0.01). There was no significant difference in the number of blood transfusions between the two groups (P 0.05). The laparoscopy group was superior to the traditional laparotomy group in the application of analgesic drugs, the recovery time of gastrointestinal function, the extraction time of urinary catheter, the drainage of abdominal cavity for 3 days, and the intake of fluid after operation (P 0.05). Especially in the time of getting out of bed, the time of entering half fluid after operation, the days of hospitalization after operation were more prominent (P = 0.01). The complications such as anastomotic fistula were found in the laparoscopic group and the traditional open group. There was no significant difference in the incidence of postoperative complications between the two groups (21.1% VS 27.8% P 0.05). There was no significant difference in recurrence, metastasis and death between the two groups under the condition of no difference in follow-up time and number of cases (P 0.05). Conclusion: laparoscopic total colectomy has the advantages of less trauma, less bleeding, less postoperative pain, faster recovery and shorter hospital stay. There was no significant difference in recurrence, metastasis and death between the two groups. It was safe and feasible to treat familial adenomatous polyposis with high clinical application value.
【学位授予单位】：重庆医科大学
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R656

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