發(fā)布時(shí)間：2018-01-28 04:09

  本文關(guān)鍵詞： 直腸腫瘤 超低位 腹腔鏡 經(jīng)括約肌間切除術(shù) 肛腸動(dòng)力學(xué)　出處：《吉林大學(xué)》2017年碩士論文　論文類(lèi)型：學(xué)位論文

【摘要】：目的:探討腹腔鏡下全直腸系膜切術(shù)聯(lián)合括約肌間切除吻合術(shù)治療T1和T2期超低位直腸癌的可行性及術(shù)后肛腸動(dòng)力學(xué)的變化。方法:回顧性分析了2010-2015年間于我院實(shí)施腹腔鏡下ISR術(shù)22例,開(kāi)腹行ISR術(shù)21例,以及同期超低位直腸癌行腹腔鏡下行Dixon術(shù)患者20例,通過(guò)分別比較腹腔鏡下ISR術(shù)與開(kāi)腹ISR術(shù)患者手術(shù)用時(shí)、術(shù)中出血、住院時(shí)間、主要術(shù)后并發(fā)癥肛門(mén)疼痛、吻合口瘺的發(fā)生情況、術(shù)后3個(gè)月及12個(gè)月Wexner評(píng)分及肛管靜息壓(ARP)、肛管最大收縮壓(MSP)、直腸最大容量(MTV)結(jié)果;以及比較腹腔鏡下ISR術(shù)與腹腔鏡下Dixon術(shù)患者術(shù)后3個(gè)月及12個(gè)月Wexner評(píng)分及肛管靜息壓(APR)、直腸最大收縮壓(MSP)、直腸最大容量(MTV),從而對(duì)ISR在腹腔鏡超低位直腸癌根治術(shù)的安全性及可行性進(jìn)行論證。結(jié)果:腹腔鏡ISR組患者手術(shù)時(shí)間(344±47)長(zhǎng)于開(kāi)腹ISR組(221±19min),術(shù)中出血量(124±55ml)少于開(kāi)腹組(210±95ml)和住院時(shí)間(11.0±2.6天)低于開(kāi)腹組(13.5±3.7天)(P0.05),其主要術(shù)后的吻合口瘺概率未見(jiàn)明顯差異(P0.05),腹腔鏡ISR組術(shù)后出現(xiàn)肛門(mén)疼痛的情況少于開(kāi)腹ISR組(P0.05),術(shù)后3及12個(gè)月Wexner評(píng)分及ARP、MSP、MTV比較果差異不顯著(P0.05)。腹腔鏡下ISR組患者與腹腔鏡下Dixon組術(shù)后3個(gè)月時(shí)Wexner肛門(mén)功能評(píng)分[(4.3±1.8)分比(2.0±1.2)分]ARP[(29.8±4.8)mm Hg比(41.6±6.7)mm Hg]MSP[(105.6±15.9)mm Hg比(119.1±19.0)mm Hg],MTV[(102.4±15.0)mm Hg比(117.7±19.3)mm Hg]明顯低于腹腔鏡Dixon組,兩組患者1年后的各項(xiàng)指標(biāo)均無(wú)統(tǒng)計(jì)學(xué)差異?結(jié)論:1.腹腔鏡下ISR術(shù)較開(kāi)腹ISR術(shù)術(shù)中出血少,住院時(shí)間短,短期效果療效好,兩者術(shù)后患者排便情況及肛門(mén)測(cè)壓結(jié)果沒(méi)有明顯差異。2.腹腔鏡下ISR術(shù)后肛門(mén)功能短期效果較腹腔鏡Dixon術(shù)后差,但是兩者再1年后功能恢復(fù)到相同水平,但差于術(shù)前。
[Abstract]:Objective: to investigate the feasibility of laparoscopic total mesorectal resection combined with sphincterotomy and anastomosis in the treatment of stage T1 and T2 ultralow rectal cancer and the changes of postoperative anorectal dynamics. A retrospective analysis of 22 cases of laparoscopic ISR was performed in our hospital from 2010 to 2015. ISR was performed in 21 patients and Dixon was performed in 20 patients with ultralow rectal cancer at the same time. The operative time of ISR under laparoscope and open ISR were compared respectively. Intraoperative bleeding, hospital stay, major postoperative complications, anal pain, anastomotic fistula, Wexner score and anal resting pressure at 3 and 12 months after operation. The results of maximum systolic pressure of anal canal (MSPN) and maximal volume of rectum (MTV); The Wexner score and anal resting pressure were compared between laparoscopic ISR and laparoscopic Dixon at 3 and 12 months postoperatively, and the rectal maximum systolic pressure (MPP) was also compared. Maximum rectal volume (MTV). The safety and feasibility of ISR in laparoscopic radical resection of ultralow rectal cancer were demonstrated. Results: the operative time of laparoscopic ISR group was 344 鹵47 longer than that of open ISR group (P < 0.05). (221 鹵19 min). The intraoperative bleeding volume (124 鹵55ml) was lower than that in the open group (210 鹵95ml) and the hospitalization time (11.0 鹵2.6 days), which was lower than that in the open group (13.5 鹵3.7 days) (P 0.05). There was no significant difference in the probability of anastomotic leakage after operation (P 0.05). The incidence of anal pain in the laparoscopic ISR group was less than that in the open ISR group (P 0.05). After 3 and 12 months, Wexner score and ARP MSPM were observed. There was no significant difference in the comparison between MTV and Dixon. Wexner anal function score of patients with Laparoscopic ISR and Laparoscopic Dixon at 3 months after Operation. [The score was 4.3 鹵1.8 vs 2.0 鹵1.2]? ARP. [29.8 鹵4.8 mm Hg vs 41.6 鹵6.7 mm Hg]? MSP. [105.6 鹵15.9 mm Hg vs 119.1 鹵19.0 mm Hg] MTV. [102.4 鹵15.0 mm Hg was significantly lower than 117.7 鹵19.3 mm Hg in Dixon group, and there was no statistical difference between the two groups after one year. Conclusion 1.Laparoscopic ISR has less bleeding, shorter hospital stay and better short-term effect than open ISR. There was no significant difference in defecation and anus manometry between the two groups. 2. The short-term effect of laparoscopic ISR on anal function was worse than that of laparoscopic Dixon. But the function returned to the same level one year later, but it was worse than that before operation.
【學(xué)位授予單位】：吉林大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類(lèi)號(hào)】：R735.37

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