腹腔镜辅助与开腹直肠前切除术对老年患者的对比研究

发布时间：2018-04-21 18:15

本文选题：直肠癌 + 腹腔镜　；参考：《吉林大学》2015年硕士论文

【摘要】：目的：对老年患者的腹腔镜辅助与开腹直肠前切除术进行比较，探讨腹腔镜辅助直肠前切除术治疗老年患者群体的可行性、安全性及临床应用价值。材料与方法：回顾性分析2010年1月至2014年4月吉林大学中日联谊医院新民院区胃肠外科行直肠癌根治术的215例老年患者资料,其中117例在腹腔镜辅助下完成直肠前切除术（腹腔镜组），其中男81例，女36例，平均年龄（75.79±2.17）岁。98例开腹完成直肠前切除术（开腹组），其中男72例，女26例，平均年龄（76.42±3.56）岁。比较两组手术平均时间，清扫淋巴结数目，术中平均出血量，手术切口长度，术后平均排气时间，平均住院总时间，平均ICU住院时间，皮下感染、吻合口瘘、肠梗阻、尿路感染、肺部感染、术后肠瘘等术后并发症发生率，术后30天内死亡率，术后1年无进展生存率等指标。结果：两组按TME原则顺利完成直肠前切除术，腹腔镜组和开腹组的手术平均时间分别为（119.56±29.70）min VS （100.23±19.76）min，术中清扫淋巴结数目分别为（19.30±4.21） VS （14.49±2.32）枚，术中平均出血量分别为（48.98±31.18）ml VS （81.37±39.76）ml，手术切口长度分别为（5.30±0.51）cm VS （18.45±2.02）cm，术后平均排气时间分别为（2.13±1.37）d VS （3.53±1.09）d，平均住院总时间分别为（6.42±1.35）d VS （8.49±2.38）d，平均ICU住院时间分别为（1.20±0.20）d VS （2.30±0.40）d，均存在统计学意义（P＜0.05）。腹腔镜组和开腹组患者的术后肠瘘发生率分别为1.71%（2/117）VS3.06%（3/98），术后皮下感染发生率分别为0.85%（1/117）VS5.10%（5/98），吻合口瘘发生率分别为1.71%（2/117）VS5.10%（5/98），肠梗阻发生率分别为2.56%（3/117）VS4.08%（4/98），尿路感染发生率分别为4.27%（5/117）VS4.08%（4/98），肺部感染发生率分别为2.56%（3/117）VS2.04%（2/98），术后30天内死亡率分别为1.71%（2/117）VS1.02%（1/98），术后1年无进展生存率分别为91.30%（105/115）VS91.75%（89/97），，均无显著差异，（P＞0.05）。结论：腹腔镜辅助直肠前切除术对于老年患者群体是可行、有效的手术方式，同样适合老年患者。
[Abstract]:Objective: to evaluate the feasibility, safety and clinical value of laparoscopic assisted anterior rectal resection (Laparoscopic anterior resection) in elderly patients. Materials and methods: data of 215 elderly patients undergoing radical resection of rectal cancer in Xinmin Hospital of Jilin University from January 2010 to April 2014 were retrospectively analyzed. Among them, 117 cases underwent anterior rectal resection (laparoscopic group, 81 cases were male, 36 cases were female, mean age was 75.79 卤2.17). 98 cases underwent anterior rectal resection (open group, 72 cases were male and 26 cases were female, mean age was 76.42 卤3.56). The mean time of operation, the number of lymph nodes dissected, the average amount of blood lost during operation, the length of incision, the average time of exhaust, the average duration of hospitalization, the average time of ICU hospitalization, subcutaneous infection, anastomotic fistula, intestinal obstruction were compared between the two groups. The incidence of postoperative complications such as urinary tract infection, pulmonary infection, postoperative intestinal fistula, mortality within 30 days after operation, and 1 year progression free survival rate were measured. Results: according to TME principle, anterior rectal resection was successfully completed in the two groups. The average operation time of laparoscopic group and open group was 119.56 卤29.70)min vs 100.23 卤19.76 min, and the number of dissected lymph nodes during operation was 19.30 卤4.21 vs 14.49 卤2.32, respectively. The average intraoperative bleeding volume was 81.37 卤39.76 ml, the operative incision length was 5.30 卤0.51)cm vs (18.45 卤2.02cm), the mean postoperative exhaust time was 2.13 卤1.37 days (vs = 3.53 卤1.09d), the total hospitalization time was 6.42 卤1.35d vs (8.49 卤2.38d), the average ICU hospitalization time was 1.20 卤0.20d vs (2.30 卤0.40d), there was significant difference between the two groups (P < 0.05). The incidence of infection was 2.56 / 117VS2.040.The mortality within 30 days after operation was 1.71 / 2117VS1.02and 1 / 98, respectively. The 1 year progression-free survival rate was 91.30v / 105VS91.758997 / 97, respectively. There was no significant difference between the two groups (P > 0.05). Conclusion: laparoscopically assisted anterior rectal resection is feasible and effective for elderly patients.
【学位授予单位】：吉林大学
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R735.37

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