【摘要】：目的：隨著腹腔鏡技術(shù)的不斷成熟,臨床經(jīng)驗(yàn)的不斷增加,手術(shù)器械的不斷進(jìn)步,腹腔鏡手術(shù)相對(duì)于傳統(tǒng)開腹手術(shù)創(chuàng)傷小、恢復(fù)快的優(yōu)勢(shì)逐漸得到認(rèn)可,并使腹腔鏡手術(shù)的應(yīng)用不斷推廣。本研究通過比較腹腔鏡下全結(jié)腸切除術(shù)與傳統(tǒng)開腹手術(shù)治療家族性腺瘤性息肉病的臨床療效,探討前者的安全性、可行性和臨床應(yīng)用價(jià)值。方法：回顧性分析我院2009年1月至2014年10月37例行全結(jié)腸切除術(shù)的FAP患者的臨床資料,其中腹腔鏡手術(shù)者19例,開腹手術(shù)組18例。通過SPSS 21.0統(tǒng)計(jì)學(xué)軟件處理患者術(shù)前、術(shù)中、術(shù)后的相關(guān)資料,分析腹腔鏡手術(shù)相對(duì)于傳統(tǒng)開腹手術(shù)的臨床效果,并結(jié)合文獻(xiàn)對(duì)此進(jìn)行討論和評(píng)價(jià)。結(jié)果：腹腔鏡組和傳統(tǒng)開腹組均順利完成手術(shù),腹腔鏡組無(wú)患者中轉(zhuǎn)開腹。在性別、年齡、體質(zhì)指數(shù)、FAP家族史、息肉惡變、術(shù)前貧血、ASA分級(jí)無(wú)明顯差異情況下(P值0.05),腹腔鏡組相較傳統(tǒng)開腹組切口長(zhǎng)度明顯縮短(5.8±0.7cm VS 19.9±1.6 cm),術(shù)中出血量明顯減少(137.9±30.1 ml VS 188.9±53.8 ml),兩組差異有顯著統(tǒng)計(jì)學(xué)意義(P值0.01)。手術(shù)時(shí)間腹腔鏡組相對(duì)于傳統(tǒng)開腹組有所延長(zhǎng)(277.8±35.9 min VS 237.8±26.9 min),且兩組差異有顯著統(tǒng)計(jì)學(xué)意義(P值0.01)。而術(shù)中輸血數(shù)兩組間差異無(wú)統(tǒng)計(jì)學(xué)意義(P值0.05)。術(shù)后恢復(fù)中腹腔鏡組在應(yīng)用鎮(zhèn)痛藥物、胃腸功能恢復(fù)時(shí)間、尿管拔除時(shí)間、腹腔3d引流量、術(shù)后進(jìn)流質(zhì)飲食等方面明顯較傳統(tǒng)開腹組有優(yōu)勢(shì)(P值0.05),特別是在下床活動(dòng)時(shí)間、術(shù)后進(jìn)半流質(zhì)時(shí)間、術(shù)后住院日方面更為突出(P值0.01)。腹腔鏡組和傳統(tǒng)開腹組均有吻合口瘺等并發(fā)癥出現(xiàn),兩組間術(shù)后并發(fā)癥發(fā)生率差異無(wú)統(tǒng)計(jì)學(xué)意義(21.1% VS 27.8% P值0.05)。兩組在隨訪時(shí)間和隨訪例數(shù)無(wú)差異情況下,復(fù)發(fā)轉(zhuǎn)移及病死情況亦無(wú)無(wú)明顯差異(P值0.05)。結(jié)論：腹腔鏡下行全結(jié)腸切除術(shù)與傳統(tǒng)開腹手術(shù)相比具有創(chuàng)傷小、術(shù)中出血少、術(shù)后疼痛輕、術(shù)后恢復(fù)快、住院日短等優(yōu)點(diǎn),而手術(shù)并發(fā)癥、復(fù)發(fā)轉(zhuǎn)移及病死情況兩組無(wú)明顯差異,其治療家族性腺瘤性息肉病是安全的可行的,具有較高的臨床應(yīng)用價(jià)值。
[Abstract]:Objective: with the development of laparoscopic technique, the increasing of clinical experience and the improvement of surgical instruments, the advantages of laparoscopic surgery with less trauma and faster recovery than traditional open surgery have been recognized. The application of laparoscopic surgery has been popularized. The purpose of this study was to compare the clinical efficacy of laparoscopic total colectomy and traditional open surgery in the treatment of familial adenomatous polyposis, and to explore the safety, feasibility and clinical value of the former. Methods: the clinical data of 37 patients with FAP undergoing total colectomy in our hospital from January 2009 to October 2014 were analyzed retrospectively. There were 19 cases of laparoscopic surgery and 18 cases of open operation group. The clinical results of laparoscopic surgery compared with traditional open surgery were analyzed by SPSS 21. 0 statistical software, and the results were discussed and evaluated in combination with the literature. Results: the laparoscopic group and the traditional open group successfully completed the operation, no patients in the laparoscopic group were converted to open surgery. There were no significant differences in sex, age, body mass index, FAP family history, polyp malignancy, preoperative anemia and ASA grade (P < 0. 05). The length of incision in the laparoscopic group was significantly shorter than that in the traditional open group (5.8 鹵0.7cm VS 19.9 鹵1.6 cm),). The amount of bleeding was significantly decreased (137.9 鹵30.1 ml VS, 188.9 鹵53.8 ml),). There was significant difference between the two groups (P 0.01). The operative time in the laparoscopic group was significantly longer than that in the traditional open group (277.8 鹵35.9 min VS 237.8 鹵26.9 min), P < 0.01). There was no significant difference in the number of blood transfusions between the two groups (P 0.05). The laparoscopy group was superior to the traditional laparotomy group in the application of analgesic drugs, the recovery time of gastrointestinal function, the extraction time of urinary catheter, the drainage of abdominal cavity for 3 days, and the intake of fluid after operation (P 0.05). Especially in the time of getting out of bed, the time of entering half fluid after operation, the days of hospitalization after operation were more prominent (P = 0.01). The complications such as anastomotic fistula were found in the laparoscopic group and the traditional open group. There was no significant difference in the incidence of postoperative complications between the two groups (21.1% VS 27.8% P 0.05). There was no significant difference in recurrence, metastasis and death between the two groups under the condition of no difference in follow-up time and number of cases (P 0.05). Conclusion: laparoscopic total colectomy has the advantages of less trauma, less bleeding, less postoperative pain, faster recovery and shorter hospital stay. There was no significant difference in recurrence, metastasis and death between the two groups. It was safe and feasible to treat familial adenomatous polyposis with high clinical application value.
【學(xué)位授予單位】：重慶醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2015
【分類號(hào)】：R656

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