腹腔镜辅助低位直肠癌保肛术与开腹低位直肠癌保肛术疗效的比较

发布时间：2018-04-25 03:02

本文选题：腹腔镜辅助 + 开腹　；参考：《大连医科大学》2015年硕士论文

【摘要】：目的:本研究总结腹腔镜辅助下低位直肠癌前切除保肛术与开腹低位直肠癌前切除保肛术患者的临床资料,进行对比分析,探讨腹腔镜辅助下低位直肠癌前切除保肛术的安全性、微创性与优越性。方法:总结大连医科大学附属第一医院2009年1月至2014年9月施行腹腔镜辅助下低位直肠癌前切除保肛术的33例病例与同期开腹低位直肠癌前切除保肛术的39例病例的临床资料,分为腹腔镜组与开腹组,对两组的手术时间,术中出血量,术后恢复情况(术后排气时间、术后排便时间、术后住院时间、给予止痛药次数),术后并发症发生率,术后病理(上下切缘、淋巴结清除数量),术后半年的肛门功能,术后局部复发率,远处转移率,术后生存时间进行对比。结果:72例患者均保留肛门,未行预防性回肠造瘘,均达到肿瘤根治性标准,腹腔镜组与开腹组手术时间分别为229min和161min,术中出血量为36ml和57ml,差异均具有统计学意义;术后排气时间分别为3天和4天,排便时间分别为9天和7天,术后平均住院时间分别为13天和18天,术后给予止痛药次数平均为1.5次和2.7次,术后半年的Wexner便秘评分分别为13分和14分,这些数据均具有统计学差异;腹腔镜组与开腹组的上下切缘均为阴性,其下切缘平均长度分别为3.5cm和2.9cm,有统计学差异;淋巴结清扫数量为16枚和13枚,无统计学差异。术后并发症发生率腹腔镜组与开腹组分别为15.1%(5/33)和35.9%(14/39),腹腔镜组明显低于开腹组,差异具有统计学意义,两组的局部复发率分别为6.0%和7.7%,远处转移率分别为9.1%和12.8%,差异无统计学意义;腹腔镜组和开腹组的平均生存时间为45.7个月和54.5个月,没有统计学差异。结论:腹腔镜低位直肠癌前切除保肛术较开腹低位直肠癌前切除保肛术具有术中出血少,术后恢复快,术后并发症少等优势,肛门功能能得到更好的保护,而在肿瘤切缘及淋巴结清扫数目方面,两组没有明显差异,在局部复发率及远处转移率、总的生存时间上也没有显著差异。腹腔镜辅助低位直肠癌前切除保肛手术具有手术安全性,微创性及肿瘤安全性,但其长期疗效,仍有待大规模,多中心研究的报道。有条件的医院对分期较早的低位直肠癌患者若切除足够的远端切缘后仍可保留肛管和肛管括约肌以及肛提肌者,应选择腹腔镜保肛手术进行治疗以提高患者生活质量。
[Abstract]:Objective: to summarize the clinical data of patients with laparoscopic assisted anterior resection of low rectal cancer and open resection of low rectal cancer. To investigate the safety, minimally invasive and superiority of laparoscopic anterior resection of low rectal cancer. Methods: from January 2009 to September 2014, 33 patients with low rectal cancer underwent laparoscopically assisted anus preservation surgery and 39 patients with low rectal cancer who underwent anus preservation surgery at the same time, from January 2009 to September 2014 in the first affiliated Hospital of Dalian Medical University. The patients were divided into two groups: laparoscopic group and laparotomy group. The operative time, blood loss, postoperative recovery (postoperative exhaust time, postoperative defecation time, postoperative hospitalization time, number of times of analgesic administration, postoperative complications) were observed in the two groups. Postoperative pathology (upper and lower incised margin, lymph node clearance, anal function half a year after operation, local recurrence rate, distant metastasis rate, survival time after operation were compared. Results the anus was retained in all the 72 patients without prophylactic ileostomy. The operative time of laparoscopy group and laparotomy group were 229min and 161 min, respectively. The amount of bleeding during operation was 36ml and 57 ml, respectively. The difference was statistically significant. The postoperative exhaust time was 3 days and 4 days, defecation time was 9 days and 7 days, postoperative average hospitalization time was 13 days and 18 days, and the average number of times of postoperative analgesic administration was 1.5 and 2.7 times. The scores of Wexner constipation were 13 points and 14 points respectively in six months after operation, and there was statistical difference between the laparoscopic group and the laparotomy group in the upper and lower incisors, the average length of the lower incisor was 3.5cm and 2.9 cm, respectively, there was statistical difference between the laparoscopic group and the laparotomy group. The number of lymph node dissection was 16 and 13, there was no statistical difference. The incidence of postoperative complications in the laparoscopy group and the open group were 15.1g / 33) and 35.9B / 14 / 39, respectively. The incidence of postoperative complications in the laparoscopic group was significantly lower than that in the open group (P < 0.05), and the difference was statistically significant. The local recurrence rates of the two groups were 6.0% and 7.7%, the distant metastasis rates were 9.1% and 12.8%, respectively, and the average survival time of the laparoscopic group and the open group were 45.7 months and 54.5 months, respectively. Conclusion: laparoscopic anus preserving surgery for low rectal cancer has the advantages of less bleeding, faster recovery, less postoperative complications and better protection of anal function. However, there was no significant difference in the number of tumor margin and lymph node dissection between the two groups, and there was no significant difference in local recurrence rate, distant metastasis rate and total survival time between the two groups. Laparoscopic assisted anus preserving surgery for low rectal cancer is safe, minimally invasive and safe. However, the long-term efficacy of laparoscopically assisted anterior resection of low rectal cancer remains to be reported in large scale and multicenter studies. In order to improve the quality of life of patients with lower rectal cancer patients with lower rectal cancer in early stage who can retain anal canal anal sphincter and levator muscle after resection of enough distal margin laparoscopic anal preservation surgery should be selected to improve the quality of life.
【学位授予单位】：大连医科大学
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R735.37

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