腹腔镜中转开腹结直肠癌手术对老年患者术后短期结局的影响

发布时间：2018-05-25 09:32

本文选题：结直肠癌 + 腹腔镜　；参考：《重庆医科大学》2017年硕士论文

【摘要】：目的研究年龄大于65岁的老年结直肠癌患者接受腹腔镜中转开腹手术后的影响。方法收集我院胃肠外科自2013年至2015年期间年龄大于65岁明确诊断为结直肠癌,符合本研究纳入标准及排除标准的手术患者,并根据患者最终施行手术方式将病人分为3组:腹腔镜组、腹腔镜中转开腹组,开腹组,所有手术均由我科高年资医师主刀,术后分析腹腔镜中转开腹手术原因、比较3组患者短期结局,将有关数据进行SPSS17.0分析。相应的观察指标包括:出血量、手术时间、术后住院时间、术后并发症(切口并发症、肺部并发症、吻合口并发症、2次手术、肠梗阻、其他并发症)。结果符合纳入标准及排除标准的共760例,其中共518例顺利完成腹腔镜手术,42例腹腔镜中转开腹手术,200例开腹手术,中转率为7.5%。中转原因主要为肿瘤局部分期晚与周围组织粘连(38%)、瘤体大、位置固定(24%)。患者术前一般资料相比无明显差异(P0.05),据肿瘤位置最终选择的手术种类相比,腹腔镜组与中转开腹组存在差异(P0.05),腹腔镜组手术时间及术中出血量较中转组少(P0.05),开腹组手术时间短于中转组,而出血量与中转组无差异(P0.05)。术后并发症方面相比中转组切口并发症、肺部并发症发生率较腹腔镜组高,术中出血量及手术时间较腹腔镜组多(P0.05);而吻合口、心脑血管并发症、术后肠梗阻及2次手术等发生率没有明显差异(P0.05)。中转组与开腹组相比各并发症发生率方面均无明显差异。结论腹腔镜结直肠癌手术对患者损伤更小、术后并发症更少,腹腔镜结直肠癌手术对老年患者是安全有效的,同时腹腔镜中转开腹手术与开腹手术相比并没给患者带来更坏的短期结局。
[Abstract]:Objective to study the effect of laparoscopy on colorectal cancer patients over 65 years old. Methods from 2013 to 2015, patients with colorectal cancer diagnosed by gastrointestinal surgery over 65 years old, who met the criteria of inclusion and exclusion of this study, were collected. The patients were divided into three groups according to the final operation mode: laparoscopy group, laparoscopy conversion group, all the operations were performed by our senior physician. The reasons of laparoscopic conversion to open surgery were analyzed after operation. The short-term outcomes of the three groups were compared and the data were analyzed by SPSS17.0. The corresponding indexes included: bleeding volume, operation time, postoperative hospitalization time, postoperative complications (incision complications, lung complications, anastomotic complications), intestinal obstruction, other complications. Results A total of 760 cases conformed to the criteria of inclusion and exclusion, of which 518 cases were successfully completed laparoscopic surgery, 42 cases were converted to laparotomy in 200 cases, the conversion rate was 7.5%. The main causes of the transfer were local stage late adhesion with the surrounding tissue and 38% of the tumor, the tumor was large, fixed at 24% of the tumor. There was no significant difference in the general data of the patients before operation (P 0.05). There was significant difference between the laparoscopy group and the conversion group (P 0.05). The operative time and blood loss in the laparoscopy group were less than those in the transfer group. The operative time in the laparotomy group was shorter than that in the transit group, but there was no difference in the bleeding volume between the laparoscopy group and the transit group. The incidence of postoperative complications was higher than that of laparoscopy group, and the amount of blood loss and operation time was more than that of laparoscopy group (P 0.05), while anastomosis, cardio-cerebrovascular complications, anastomosis, cardiovascular and cerebrovascular complications were more common than those in laparoscopy group. There was no significant difference in the incidence of intestinal obstruction and two operations after operation (P 0.05). There was no significant difference in the incidence of complications between the transfer group and the open group. Conclusion Laparoscopic colorectal cancer surgery has less injury and less postoperative complications. Laparoscopic colorectal cancer surgery is safe and effective for elderly patients. At the same time, laparoscopic conversion to open surgery did not bring a worse short-term outcome than open surgery.
【学位授予单位】：重庆医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R735.34

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