腹腔镜联合术中肠镜治疗结直肠癌的临床分析

发布时间：2018-07-29 13:45

【摘要】：研究背景:腹腔镜手术治疗结直肠癌疗效确切,且有“手术视野清晰、创伤小、术后恢复快”等优点,但其并不能成为治疗结直肠癌的标准化、单一化手术模式。原因可能是腹腔镜手术主要是根据腹腔镜显像信息如肠管体积改变、肠管浆膜层受侵犯、局部淋巴结肿大等情况判断病情,而缺乏“手”的精细触觉。对于大部分肿瘤体积较小的结直肠癌患者,术中难以准确判断肿瘤位置,也就难以确定精准的手术切除范围,可能会造成“治疗不足”或“治疗过度”的后果。本研究通过比较腹腔镜联合术中肠镜手术、单纯腹腔镜手术治疗结直肠癌的临床疗效,旨在探讨腹腔镜联合术中肠镜治疗结直肠癌的安全性、有效性。材料和方法:回顾性分析2011年1月至2015年12月贵港市人民医院胃肠外科收治的186例结直肠癌患者的临床资料。其中腹腔镜联合术中肠镜治疗(联合组)84例,腹腔镜治疗(腔镜组)102例。两组患者的临床术前资料有可比性。比较2组术中出血量、手术时间、胃肠功能恢复时间、术后住院天数、平均切缘、平均淋巴结清扫数目、二次手术次数(包括术中处理吻合口、术中追加手术)、并发症情况(吻合口如出血、漏及心肺脑并发症)、出院后随访情况等,以探讨腹腔镜联合术中肠镜治疗结直肠癌的安全性、有效性。结果:两组手术均顺利完成,2组手术时间、术中出血比较差异无统计学意义(t值分别为2.518、1.924,P值分别为0.057、0.077)。联合组吻合口术中追加缝扎10例,其中吻合不满意7例,出血3例;腔镜组4例(均为出血),比较差异有统计学意义(χ2=4.218,P=0.040)。腔镜组术中追加手术(切缘不足,同期追加扩大切除范围)9例,联合组0例,比较有统计学意义(χ2=7.789,P=0.005)。2组术后首次肛门排气、排便时间、进食时间以及术后住院时间比较差异无统计学意义(t值分别为1.482、1.726、1.653、2.451,P值分别为0.327、0.518、0.483、0.752)。吻合口并发症:联合组吻合口漏2例(2.38%),均保守治愈;腔镜组吻合口漏7例、出血3例,共10例(9.80%),其中4例经2次手术治愈,两组吻合口并发症发生率比较差异有统计学意义(χ2=4.205,P=0.040)。联合组术后感染12例(腹腔感染2例、切口感染5例、肺部感染2例、尿路感染3例),腔镜组13例(腹腔感染2例、切口感染4例、肺部感染3例、尿路感染4例)比较差异无统计学意义(χ2=0.094,P=0.759)。标本肿瘤学情况:两组平均结肠标本长度、直肠标本长度、结肠远切缘长度、直肠远切缘长度及淋巴结数等比较差异无统计学意义(t值分别为2.615、1.476、0.453、1.145、0.912,P值分别为0.072、0.135、0.604、0.215、0.367);两组切缘阳性比较差异无统计学意义(χ2=2.421,P=0.120)。结论:1.腹腔镜联合术中肠镜治疗结直肠癌是安全可行的。2.两镜联合,可对病灶进行立体观察,两者优势互补,能够达到“精确”的手术切除,实现微创治疗的优势最大化,也能够更好的体现“肿瘤根治原则”。
[Abstract]:Background: laparoscopic surgery is effective in the treatment of colorectal cancer, and has the advantages of "clear surgical field, less trauma and quick recovery", but it can not be used as a standardized and single surgical mode for colorectal cancer. The reason may be that laparoscopic surgery is mainly based on the information of laparoscopic imaging, such as intestinal volume changes, intestinal serous layer invasion, local lymphadenopathy and so on, but lack of "hand" fine tactile. For most colorectal cancer patients with small tumor size, it is difficult to accurately judge the location of the tumor during operation, and it is difficult to determine the exact range of surgical resection, which may lead to the consequences of "inadequate treatment" or "over-treatment". The purpose of this study was to evaluate the safety and efficacy of laparoscopy combined with intraoperative colonoscopy in the treatment of colorectal cancer. Materials and methods: the clinical data of 186 patients with colorectal cancer treated in gastrointestinal surgery department of Guigang Municipal people's Hospital from January 2011 to December 2015 were analyzed retrospectively. Among them, 84 cases were treated by laparoscopy combined with endoscopy (combined group), 102 cases were treated by laparoscopy (endoscopic group). The preoperative clinical data of the two groups were comparable. Blood loss, operation time, gastrointestinal function recovery time, postoperative hospitalization days, average incision margin, average number of lymph node dissection, number of secondary operations (including anastomotic stoma management during operation) were compared between the two groups. In order to evaluate the safety and efficacy of laparoscopy combined with endoscopy in the treatment of colorectal cancer, the complications (such as anastomotic bleeding, leakage, cardiopulmonary and cerebral complications) and follow-up after discharge were discussed in order to explore the safety and efficacy of laparoscopy combined with endoscopy in the treatment of colorectal cancer. Results: the operation time of the two groups was successfully completed and there was no significant difference in intraoperative bleeding (t = 2.518 ~ 1.924 P = 0.057 卤0.077). In the combined group, 10 cases were sutured during anastomosis, among which 7 cases were dissatisfied with anastomosis, 3 cases were bleeding, and 4 cases (all bleeding) in the endoscopic group, the difference was statistically significant (蠂 2 + 4.218). There were 9 cases in the endoscopic group and 0 cases in the combined group. There was significant difference between the two groups (蠂 2, 7.789, P0. 005) in the first time of anal exhaust and defecation after operation in group 2, and the time of anal exhaust and defecation in the combined group was significantly higher than that in the control group (P 0. 005). There was no significant difference in feeding time and hospitalization time after operation (t = 1.482U 1.726U 1.653U 2.451g P = 0.327g 0.518 卤0.483n 0.752, respectively). Anastomotic complications: anastomotic leakage occurred in 2 cases (2.38%) in the combined group and anastomotic leakage in 7 cases (9. 80%) in the endoscopic group and in 3 cases (9. 80%), among which 4 cases were cured by two operations. There was a significant difference in the incidence of anastomotic complications between the two groups (蠂 2. 205 P 0. 040). There were 12 cases of postoperative infection (2 cases of abdominal infection, 5 cases of incision infection, 2 cases of pulmonary infection and 3 cases of urinary tract infection) in the combined group, 13 cases in the endoscopic group (2 cases of abdominal infection, 4 cases of incision infection, 3 cases of pulmonary infection). There was no significant difference in urinary tract infection in 4 cases (蠂 2, 0.094, P < 0. 759). Oncology of specimens: the average length of colonic specimens, rectum specimens, and distal margin of colon were measured in both groups. There was no significant difference in the length of rectum distal margin and the number of lymph nodes between the two groups (t = 2.6151.476U 0.453U 1.145U 0.912P = 0.0720.135U 0.6040.2150.367), and there was no significant difference between the two groups (蠂 22.421P 0.120). Conclusion 1. Laparoscopy combined with endoscopy is a safe and feasible method for colorectal cancer. The combination of two endoscopes can make stereoscopic observation of the lesions. They complement each other, which can achieve "accurate" surgical resection, maximize the advantages of minimally invasive treatment, and better reflect the "principle of radical resection of tumor".
【学位授予单位】：广西医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R735.34

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