本文選題：直腸癌　切入點(diǎn)：腹腔鏡　出處：《青海大學(xué)》2017年碩士論文

【摘要】：目的:探討腹腔鏡輔助下直腸癌TME與傳統(tǒng)開腹直腸癌TME治療中低位直腸癌的安全性及近期療效。方法:收集青海大學(xué)附屬醫(yī)院胃腸腫瘤外科2014年10月-2016年10月之間完成的腹腔鏡輔助下直腸癌TME和開腹直腸癌TME的患者病歷資料共89例,以行腹腔鏡TME的47例為觀察組(其中直腸低位前切除術(shù)(LAR)30例,腹會(huì)陰聯(lián)合直腸癌根治術(shù)(APR)17例),開腹TME的42例(其中直腸低位前切除術(shù)(LAR)28例,腹會(huì)陰聯(lián)合直腸癌根治術(shù)(APR)14例)為對(duì)照組進(jìn)行回顧性分析。比較兩種術(shù)式在手術(shù)時(shí)間、術(shù)中出血量、上下切緣、環(huán)周切緣、淋巴結(jié)清掃數(shù)目、留置尿管時(shí)間、留置引流管時(shí)間、通氣時(shí)間、恢復(fù)進(jìn)食時(shí)間、下床時(shí)間、術(shù)后近期并發(fā)癥及術(shù)后住院天數(shù)等方面的差異,得出結(jié)果并進(jìn)行分析與討論。結(jié)果:兩組病例的手術(shù)時(shí)間(167.62±38.11 min,162.43±36.51 min)、上下切緣和環(huán)周切緣陽性例數(shù)以及術(shù)中清掃淋巴結(jié)數(shù)(14.47±2.24個(gè),15.33±3.08個(gè))差異無統(tǒng)計(jì)學(xué)意義(P0.05);而術(shù)中出血量(87.34±39.84 ml,162.95±68.83 ml)、留置尿管時(shí)間(2.60±1.06 d,3.29±1.09 d)、留置引流管時(shí)間(5.36±1.05 d,6.76±1.68 d)、通氣時(shí)間(2.28±0.99 d,3.05±1.21 d)、恢復(fù)進(jìn)食時(shí)間(3.36±1.19 d,4.48±1.49 d)、下床時(shí)間(2.40±0.90 d,3.50±1.27 d)術(shù)后住院天數(shù)(9.04±1.30 d,13.24±2.47 d)統(tǒng)計(jì)學(xué)差異顯著(P0.05);術(shù)后近期并發(fā)癥,腹腔鏡組共3例,發(fā)生率6.4%,開腹組共10例,發(fā)生率23.8%,兩組患者在切口感染發(fā)生率及并發(fā)癥總發(fā)生率方面差異顯著(P0.05),其他并發(fā)癥無顯著統(tǒng)計(jì)學(xué)差異(P0.05)。根據(jù)術(shù)后外科并發(fā)癥Clavien-Dindo分級(jí)方法統(tǒng)計(jì)分析,兩組患者在Ⅰ級(jí)并發(fā)癥(主要為切口感染)發(fā)生率和并發(fā)癥總發(fā)生率方面差異顯著(P0.05),Ⅱ級(jí)及以上并發(fā)癥無顯著統(tǒng)計(jì)學(xué)差異(P0.05)。結(jié)論:(1)腹腔鏡直腸癌TME是安全可行的;(2)腹腔鏡直腸癌TME的腫瘤根治性和手術(shù)時(shí)間可達(dá)到與開腹直腸癌TME相當(dāng)?shù)男Ч?(3)腹腔鏡直腸癌TME術(shù)中出血量更少、術(shù)后恢復(fù)更快,近期療效優(yōu)于開腹手術(shù)。
[Abstract]:Objective: to investigate the safety and short-term efficacy of laparoscopic assisted rectal cancer (TME) and traditional open rectal cancer (TME) in the treatment of middle and low rectal cancer. Methods: from October 2014 to October 2016, we collected gastrointestinal cancer surgery in the affiliated hospital of Qinghai University. A total of 89 patients with laparoscopically assisted rectal cancer (TME) and open rectal cancer (TME) were enrolled in this study. 47 cases of laparoscopic TME were treated as observation group (30 cases of low rectal anterior resection, 17 cases of radical resection of abdominal perineum combined with rectal cancer, 42 cases of open TME (28 cases of low rectal anterior resection). 14 cases of abdominal perineum combined with radical resection of rectal cancer were retrospectively analyzed as control group. The operative time, intraoperative blood loss, upper and lower incisal margin, circumferential margin, number of lymph node dissection, time of indwelling urethral catheter, time of indwelling drainage tube were compared. The differences of ventilation time, time of food recovery, time of getting out of bed, postoperative complications and days of hospitalization, etc. Results: the operative time was 167.62 鹵38.11 min 162.43 鹵36.51 min, the positive cases of upper and lower incisors and circumferential incisors and the number of dissected lymph nodes during operation were 14.47 鹵2.24 (15.33 鹵3.08), but there was no significant difference in intraoperative bleeding (P0.05). The volume was 87.34 鹵39.84 ml / d 162.95 鹵68.83 ml / L, the time of indwelling urethral catheter was 2.60 鹵1.06 days / 3.29 鹵1.09 days, the time of indwelling drainage tube was 5.36 鹵1.05 鹵1.68 days, the time of ventilation was 2.28 鹵0.99 days / 3.05 鹵1.21 days, the time of food recovery was 3.36 鹵1.19 days / 4.48 鹵1.49 days, the time of getting out of bed was 2.40 鹵0.90 days / 3.50 鹵1.27 days) the difference of postoperative hospitalization time was significant (P < 0.05). There were 3 cases in the laparoscopy group and 10 cases in the open group. There was significant difference in the incidence of incision infection and the total incidence of complications between the two groups (P 0.05), but there was no significant difference in other complications (P 0.05). According to the Clavien-Dindo classification method of postoperative surgical complications, there was no significant difference between the two groups. There was significant difference between the two groups in the incidence of grade 鈪，

本文編號(hào)：1693173