本文選題：直腸癌 + 腹腔鏡��； 參考：《吉林大學(xué)》2015年碩士論文

【摘要】：目的：對(duì)老年患者的腹腔鏡輔助與開(kāi)腹直腸前切除術(shù)進(jìn)行比較，探討腹腔鏡輔助直腸前切除術(shù)治療老年患者群體的可行性、安全性及臨床應(yīng)用價(jià)值。 材料與方法：回顧性分析2010年1月至2014年4月吉林大學(xué)中日聯(lián)誼醫(yī)院新民院區(qū)胃腸外科行直腸癌根治術(shù)的215例老年患者資料,其中117例在腹腔鏡輔助下完成直腸前切除術(shù)（腹腔鏡組），其中男81例，女36例，平均年齡（75.79±2.17）歲。98例開(kāi)腹完成直腸前切除術(shù)（開(kāi)腹組），其中男72例，女26例，平均年齡（76.42±3.56）歲。比較兩組手術(shù)平均時(shí)間，清掃淋巴結(jié)數(shù)目，術(shù)中平均出血量，手術(shù)切口長(zhǎng)度，術(shù)后平均排氣時(shí)間，平均住院總時(shí)間，平均ICU住院時(shí)間，皮下感染、吻合口瘺、腸梗阻、尿路感染、肺部感染、術(shù)后腸瘺等術(shù)后并發(fā)癥發(fā)生率，術(shù)后30天內(nèi)死亡率，術(shù)后1年無(wú)進(jìn)展生存率等指標(biāo)。 結(jié)果：兩組按TME原則順利完成直腸前切除術(shù)，腹腔鏡組和開(kāi)腹組的手術(shù)平均時(shí)間分別為（119.56±29.70）min VS （100.23±19.76）min，術(shù)中清掃淋巴結(jié)數(shù)目分別為（19.30±4.21） VS （14.49±2.32）枚，術(shù)中平均出血量分別為（48.98±31.18）ml VS （81.37±39.76）ml，手術(shù)切口長(zhǎng)度分別為（5.30±0.51）cm VS （18.45±2.02）cm，術(shù)后平均排氣時(shí)間分別為（2.13±1.37）d VS （3.53±1.09）d，平均住院總時(shí)間分別為（6.42±1.35）d VS （8.49±2.38）d，平均ICU住院時(shí)間分別為（1.20±0.20）d VS （2.30±0.40）d，均存在統(tǒng)計(jì)學(xué)意義（P＜0.05）。腹腔鏡組和開(kāi)腹組患者的術(shù)后腸瘺發(fā)生率分別為1.71%（2/117）VS3.06%（3/98），術(shù)后皮下感染發(fā)生率分別為0.85%（1/117）VS5.10%（5/98），吻合口瘺發(fā)生率分別為1.71%（2/117）VS5.10%（5/98），腸梗阻發(fā)生率分別為2.56%（3/117）VS4.08%（4/98），尿路感染發(fā)生率分別為4.27%（5/117）VS4.08%（4/98），肺部感染發(fā)生率分別為2.56%（3/117）VS2.04%（2/98），術(shù)后30天內(nèi)死亡率分別為1.71%（2/117）VS1.02%（1/98），術(shù)后1年無(wú)進(jìn)展生存率分別為91.30%（105/115）VS91.75%（89/97），，均無(wú)顯著差異，（P＞0.05）。 結(jié)論：腹腔鏡輔助直腸前切除術(shù)對(duì)于老年患者群體是可行、有效的手術(shù)方式，同樣適合老年患者。
[Abstract]:Objective: to evaluate the feasibility, safety and clinical value of laparoscopic assisted anterior rectal resection (Laparoscopic anterior resection) in elderly patients. Materials and methods: data of 215 elderly patients undergoing radical resection of rectal cancer in Xinmin Hospital of Jilin University from January 2010 to April 2014 were retrospectively analyzed. Among them, 117 cases underwent anterior rectal resection (laparoscopic group, 81 cases were male, 36 cases were female, mean age was 75.79 鹵2.17). 98 cases underwent anterior rectal resection (open group, 72 cases were male and 26 cases were female, mean age was 76.42 鹵3.56). The mean time of operation, the number of lymph nodes dissected, the average amount of blood lost during operation, the length of incision, the average time of exhaust, the average duration of hospitalization, the average time of ICU hospitalization, subcutaneous infection, anastomotic fistula, intestinal obstruction were compared between the two groups. The incidence of postoperative complications such as urinary tract infection, pulmonary infection, postoperative intestinal fistula, mortality within 30 days after operation, and 1 year progression free survival rate were measured. Results: according to TME principle, anterior rectal resection was successfully completed in the two groups. The average operation time of laparoscopic group and open group was 119.56 鹵29.70)min vs 100.23 鹵19.76 min, and the number of dissected lymph nodes during operation was 19.30 鹵4.21 vs 14.49 鹵2.32, respectively. The average intraoperative bleeding volume was 81.37 鹵39.76 ml, the operative incision length was 5.30 鹵0.51)cm vs (18.45 鹵2.02cm), the mean postoperative exhaust time was 2.13 鹵1.37 days (vs = 3.53 鹵1.09d), the total hospitalization time was 6.42 鹵1.35d vs (8.49 鹵2.38d), the average ICU hospitalization time was 1.20 鹵0.20d vs (2.30 鹵0.40d), there was significant difference between the two groups (P < 0.05). The incidence of infection was 2.56 / 117VS2.040.The mortality within 30 days after operation was 1.71 / 2117VS1.02and 1 / 98, respectively. The 1 year progression-free survival rate was 91.30v / 105VS91.758997 / 97, respectively. There was no significant difference between the two groups (P > 0.05). Conclusion: laparoscopically assisted anterior rectal resection is feasible and effective for elderly patients.
【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】：2015
【分類號(hào)】：R735.37

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