三孔腹腔镜直肠癌术后泌尿生殖功能研究

发布时间：2018-06-17 23:18

本文选题：直肠癌 + 腹腔镜手术　；参考：《上海交通大学》2015年博士论文

【摘要】：第一部分：三孔腹腔镜直肠癌手术可行性研究目的：近年来,陆续有人提出腹腔镜直肠癌手术的新技术,是对传统常规腹腔镜术式的补充与发展。这些新的技术各有特点,但目前均未被广泛推广。大部分新技术的安全性、可行性尚待进一步论证。我们自2011年提出“三孔”腹腔镜直肠癌根治术,至今已累积了不少病例。本文目的在于比较这一技术与常规腹腔镜技术,并进一步论证该技术的可行性。方法：回顾2013年6月至2014年12月,笔者研究团队所行腹腔镜直肠癌手术病例,行回顾性病例对照研究。依据特定的纳入标准筛选合适病人,归入“三孔组”和“常规组”(包括“四孔”和“五孔”腹腔镜直肠癌手术)。就术前基本情况、肿瘤特点、术中情况、短期预后、标本情况等方面展开比较。结果：经过筛选总共175例病例符合条件,纳入研究。排除接受腹会阴联合切除的病人,得到三孔组80例,常规组66例。两组病人的基本术前情况在年龄、性别比例、BMI、T分期、N分期方面数据无显著差异。在肿块位置的比较上,三孔组肿块位置较常规组位置高,差异显著(P=0.000)。术中情况各项指标,两组并无显著差异。术后短期预后上,三孔组有5(6.3%)例出现了吻合口瘘,常规组6(9.1%)例；三孔组另有2(2.5%)例术后短期内肠梗阻病例,常规组无此病例。在此次研究中,这两类并发症的总发生率为8.9%。除此之外,两组在开放饮食时间、留置导尿及术后住院时间上,无显著差异。结论：对于中高位直肠癌病人,三孔技术可以取得与常规腹腔镜直肠癌手术相当的手术效果。在低位直肠癌、肥胖病人中,三孔技术的应用尚需更多研究支持。第二部分：三孔腹腔镜直肠癌术后泌尿生殖功能研究目的：随着直肠癌治疗水平的不断提高,我们在直肠癌病人的生存率方面已经取得了巨大的进步。随之而来的,患者对术后功能保留的需求也越来越高。关于腹腔镜直肠癌手术后,泌尿生殖功能保留情况的研究并不丰富,尤其是对于腹腔镜新技术,更缺乏这方面数据。本篇文章的目的,在于研究腹腔镜技术对保留直肠癌手术后泌尿生殖功能的作用,以及泌尿生殖功能障碍的危险因素。重点探讨腹腔镜新技术——“三孔”腹腔镜直肠癌手术对术后功能的影响。方法：回顾2013年6月至2014年12月,笔者研究团队所行腹腔镜直肠癌手术病例,行回顾性病例对照研究。依据特定的纳入标准筛选合适病人,归入“三孔组”和“常规组”。收集术前基本情况、肿块特点、手术类型、病理资料、术后并发症、后续治疗等随访资料。另外,采用IPSS、IIEF、FSFI量表,评估病例术后泌尿、性功能。对数据进行统计分析。结果：经过筛选共111例病人纳入研究,其中“三孔组”病例49例,“常规组“病例62例；所有病例中男性69例,女性42例。在对基础情况的组间比较中,在中位年龄(P=0.014),手术类型(P=0.002),肿块距肛缘距离(P=0.000),术后化疗(P=0.022)这四个方面显示出差异。两组男性病人的性功能评分在术前、术后一月、术后三月未表现出显著性差异,但在术后半年(P=0.026)、术后一年(P=0.017)时,“三孔组”好于“常规组”。对男性术后性功能行多因素分析,发现仅BMI(P=0.022)对术后性功能存在明显影响,孔数与术后性功能相关性不明显。女性病例性功能随访中失访较多。对术后泌尿功能行单因素分析,发现手术的类型(P=0.058)、肿块的位置(P=0.056,0.043)、术后放疗(P=0.024)对泌尿功能的影响达到了统计显著差异,而在多因素分析时,各项因素对结果均无显著影响。孔数对泌尿功能预后相关性不明显。结论：三孔腹腔镜直肠癌手术与常规腹腔镜手术,在术后泌尿生殖功能上,并无明显差异。术中神经的暴露与保护在合适病例中,可达到与常规腹腔镜手术相同的水平,提示三孔技术安全可行。
[Abstract]:The first part: the feasibility study of three hole laparoscopic surgery for rectal cancer: in recent years, new techniques for laparoscopic rectal cancer have been proposed, which are complementary and developed to traditional conventional laparoscopic surgery. These new techniques have their own characteristics but are not widely popularized. The safety and feasibility of most new technologies have yet to be advanced. The purpose of this study is to compare this technique with conventional laparoscopy and to further demonstrate the feasibility of this technique. Methods: a retrospective review of the laparoscopic rectal cancer surgery from June 2013 to December 2014. A retrospective case control study was performed. The appropriate patients were selected according to the specific inclusion criteria and included in the "three holes" group and the "routine group" (including the "four holes" and "five holes" laparoscopic rectal cancer surgery). The preoperative basic conditions, tumor characteristics, intraoperative conditions, short-term, and specimen conditions were compared. Results: after screening, the results were screened. A total of 175 cases were included in the study. The patients were excluded from the co resection of the abdominal perineum, 80 cases in the three hole group and 66 cases in the routine group. The basic preoperative conditions of the two groups were not significantly different in age, sex ratio, BMI, T staging, and N staging. The difference was significant (P=0.000). There was no significant difference between the two groups. In the short term prognosis, there were 5 (6.3%) cases of anastomotic fistula in the three hole group, 6 (9.1%) in the routine group, and 2 (2.5%) in the three hole group, and there were no cases in the conventional group. In this study, the total incidence of these two complications was 8.9%.. In addition, there is no significant difference between the two groups in the open diet time, indwelling catheterization and postoperative hospitalization. Conclusion: for the patients with middle and high rectal cancer, the three hole technique can be equivalent to the conventional laparoscopic operation for rectal cancer. In the low rectal cancer patients, the application of the three hole technique still needs more research support. The two part: the study of urinary and reproductive function after three hole laparoscopic rectal cancer surgery: with the continuous improvement of the treatment level of rectal cancer, we have made great progress in the survival rate of rectal cancer patients. The study of reproductive function retention is not abundant, especially for new laparoscopic techniques. The purpose of this article is to study the role of laparoscopy in preserving urogenital function after the operation of rectal cancer and the risk factors of urogenital dysfunction. The focus is to explore the new laparoscopic technique - "three The effect of laparoscopic rectal cancer surgery on postoperative function. Methods: a retrospective case control study was performed from June 2013 to December 2014. A retrospective case control study was performed. The appropriate patients were selected according to the specific inclusion criteria and included in the "three hole group" and the "routine group". Block characteristics, surgical types, pathological data, postoperative complications, follow-up treatment and other follow-up data. In addition, the IPSS, IIEF, FSFI scales were used to assess the urinary and sexual functions of the cases after the operation. The data were statistically analyzed. Results: a total of 111 patients were selected to be included in the study, including 49 cases of "three hole" cases, 62 cases of "conventional group" cases, and all diseases. In the case of 69 male and 42 female cases, the difference between the middle age (P=0.014), the type of operation (P=0.002), the distance from the tumor to the anal margin (P=0.000), and the postoperative chemotherapy (P=0.022) were shown in the four aspects. The sexual function scores of the two groups of men were not significantly different before and after the operation one month after the operation, but in March. Three months after the operation (P=0.026) and one year after the operation (P=0.017), the three hole group was better than the conventional group. The sexual function of the male was analyzed by multiple factors. It was found that only BMI (P=0.022) had obvious influence on the postoperative sexual function, and the correlation between the number of holes and the postoperative sexual function was not obvious. The single factor analysis showed that the type of operation (P=0.058), the location of the lump (P=0.056,0.043), the effect of postoperative radiotherapy (P=0.024) on the urinary function had reached significant difference, while in the multifactor analysis, all the factors had no significant influence on the results. There is no significant difference in the postoperative urogenital function between the operation and the conventional laparoscopy. The exposure and protection of the nerve in the appropriate cases can reach the same level as that of the conventional laparoscopy, suggesting that the three hole technique is safe and feasible.
【学位授予单位】：上海交通大学
【学位级别】：博士
【学位授予年份】：2015
【分类号】：R735.37

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