腹腔镜辅助下直肠癌TME的临床研究

发布时间：2018-04-01 00:28

  本文选题：直肠癌　切入点：腹腔镜　出处：《青海大学》2017年硕士论文

【摘要】：目的:探讨腹腔镜辅助下直肠癌TME与传统开腹直肠癌TME治疗中低位直肠癌的安全性及近期疗效。方法:收集青海大学附属医院胃肠肿瘤外科2014年10月-2016年10月之间完成的腹腔镜辅助下直肠癌TME和开腹直肠癌TME的患者病历资料共89例,以行腹腔镜TME的47例为观察组(其中直肠低位前切除术(LAR)30例,腹会阴联合直肠癌根治术(APR)17例),开腹TME的42例(其中直肠低位前切除术(LAR)28例,腹会阴联合直肠癌根治术(APR)14例)为对照组进行回顾性分析。比较两种术式在手术时间、术中出血量、上下切缘、环周切缘、淋巴结清扫数目、留置尿管时间、留置引流管时间、通气时间、恢复进食时间、下床时间、术后近期并发症及术后住院天数等方面的差异,得出结果并进行分析与讨论。结果:两组病例的手术时间(167.62±38.11 min,162.43±36.51 min)、上下切缘和环周切缘阳性例数以及术中清扫淋巴结数(14.47±2.24个,15.33±3.08个)差异无统计学意义(P0.05);而术中出血量(87.34±39.84 ml,162.95±68.83 ml)、留置尿管时间(2.60±1.06 d,3.29±1.09 d)、留置引流管时间(5.36±1.05 d,6.76±1.68 d)、通气时间(2.28±0.99 d,3.05±1.21 d)、恢复进食时间(3.36±1.19 d,4.48±1.49 d)、下床时间(2.40±0.90 d,3.50±1.27 d)术后住院天数(9.04±1.30 d,13.24±2.47 d)统计学差异显著(P0.05);术后近期并发症,腹腔镜组共3例,发生率6.4%,开腹组共10例,发生率23.8%,两组患者在切口感染发生率及并发症总发生率方面差异显著(P0.05),其他并发症无显著统计学差异(P0.05)。根据术后外科并发症Clavien-Dindo分级方法统计分析,两组患者在Ⅰ级并发症(主要为切口感染)发生率和并发症总发生率方面差异显著(P0.05),Ⅱ级及以上并发症无显著统计学差异(P0.05)。结论:(1)腹腔镜直肠癌TME是安全可行的;(2)腹腔镜直肠癌TME的肿瘤根治性和手术时间可达到与开腹直肠癌TME相当的效果;(3)腹腔镜直肠癌TME术中出血量更少、术后恢复更快,近期疗效优于开腹手术。
[Abstract]:Objective: to investigate the safety and short-term efficacy of laparoscopic assisted rectal cancer (TME) and traditional open rectal cancer (TME) in the treatment of middle and low rectal cancer. Methods: from October 2014 to October 2016, we collected gastrointestinal cancer surgery in the affiliated hospital of Qinghai University. A total of 89 patients with laparoscopically assisted rectal cancer (TME) and open rectal cancer (TME) were enrolled in this study. 47 cases of laparoscopic TME were treated as observation group (30 cases of low rectal anterior resection, 17 cases of radical resection of abdominal perineum combined with rectal cancer, 42 cases of open TME (28 cases of low rectal anterior resection). 14 cases of abdominal perineum combined with radical resection of rectal cancer were retrospectively analyzed as control group. The operative time, intraoperative blood loss, upper and lower incisal margin, circumferential margin, number of lymph node dissection, time of indwelling urethral catheter, time of indwelling drainage tube were compared. The differences of ventilation time, time of food recovery, time of getting out of bed, postoperative complications and days of hospitalization, etc. Results: the operative time was 167.62 卤38.11 min 162.43 卤36.51 min, the positive cases of upper and lower incisors and circumferential incisors and the number of dissected lymph nodes during operation were 14.47 卤2.24 (15.33 卤3.08), but there was no significant difference in intraoperative bleeding (P0.05). The volume was 87.34 卤39.84 ml / d 162.95 卤68.83 ml / L, the time of indwelling urethral catheter was 2.60 卤1.06 days / 3.29 卤1.09 days, the time of indwelling drainage tube was 5.36 卤1.05 卤1.68 days, the time of ventilation was 2.28 卤0.99 days / 3.05 卤1.21 days, the time of food recovery was 3.36 卤1.19 days / 4.48 卤1.49 days, the time of getting out of bed was 2.40 卤0.90 days / 3.50 卤1.27 days) the difference of postoperative hospitalization time was significant (P < 0.05). There were 3 cases in the laparoscopy group and 10 cases in the open group. There was significant difference in the incidence of incision infection and the total incidence of complications between the two groups (P 0.05), but there was no significant difference in other complications (P 0.05). According to the Clavien-Dindo classification method of postoperative surgical complications, there was no significant difference between the two groups. There was significant difference between the two groups in the incidence of grade 鈪，

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