本文選題：腹腔鏡輔助 + 開(kāi)腹�。� 參考：《大連醫(yī)科大學(xué)》2015年碩士論文

【摘要】：目的:本研究總結(jié)腹腔鏡輔助下低位直腸癌前切除保肛術(shù)與開(kāi)腹低位直腸癌前切除保肛術(shù)患者的臨床資料,進(jìn)行對(duì)比分析,探討腹腔鏡輔助下低位直腸癌前切除保肛術(shù)的安全性、微創(chuàng)性與優(yōu)越性。方法:總結(jié)大連醫(yī)科大學(xué)附屬第一醫(yī)院2009年1月至2014年9月施行腹腔鏡輔助下低位直腸癌前切除保肛術(shù)的33例病例與同期開(kāi)腹低位直腸癌前切除保肛術(shù)的39例病例的臨床資料,分為腹腔鏡組與開(kāi)腹組,對(duì)兩組的手術(shù)時(shí)間,術(shù)中出血量,術(shù)后恢復(fù)情況(術(shù)后排氣時(shí)間、術(shù)后排便時(shí)間、術(shù)后住院時(shí)間、給予止痛藥次數(shù)),術(shù)后并發(fā)癥發(fā)生率,術(shù)后病理(上下切緣、淋巴結(jié)清除數(shù)量),術(shù)后半年的肛門功能,術(shù)后局部復(fù)發(fā)率,遠(yuǎn)處轉(zhuǎn)移率,術(shù)后生存時(shí)間進(jìn)行對(duì)比。結(jié)果:72例患者均保留肛門,未行預(yù)防性回腸造瘺,均達(dá)到腫瘤根治性標(biāo)準(zhǔn),腹腔鏡組與開(kāi)腹組手術(shù)時(shí)間分別為229min和161min,術(shù)中出血量為36ml和57ml,差異均具有統(tǒng)計(jì)學(xué)意義;術(shù)后排氣時(shí)間分別為3天和4天,排便時(shí)間分別為9天和7天,術(shù)后平均住院時(shí)間分別為13天和18天,術(shù)后給予止痛藥次數(shù)平均為1.5次和2.7次,術(shù)后半年的Wexner便秘評(píng)分分別為13分和14分,這些數(shù)據(jù)均具有統(tǒng)計(jì)學(xué)差異;腹腔鏡組與開(kāi)腹組的上下切緣均為陰性,其下切緣平均長(zhǎng)度分別為3.5cm和2.9cm,有統(tǒng)計(jì)學(xué)差異;淋巴結(jié)清掃數(shù)量為16枚和13枚,無(wú)統(tǒng)計(jì)學(xué)差異。術(shù)后并發(fā)癥發(fā)生率腹腔鏡組與開(kāi)腹組分別為15.1%(5/33)和35.9%(14/39),腹腔鏡組明顯低于開(kāi)腹組,差異具有統(tǒng)計(jì)學(xué)意義,兩組的局部復(fù)發(fā)率分別為6.0%和7.7%,遠(yuǎn)處轉(zhuǎn)移率分別為9.1%和12.8%,差異無(wú)統(tǒng)計(jì)學(xué)意義;腹腔鏡組和開(kāi)腹組的平均生存時(shí)間為45.7個(gè)月和54.5個(gè)月,沒(méi)有統(tǒng)計(jì)學(xué)差異。結(jié)論:腹腔鏡低位直腸癌前切除保肛術(shù)較開(kāi)腹低位直腸癌前切除保肛術(shù)具有術(shù)中出血少,術(shù)后恢復(fù)快,術(shù)后并發(fā)癥少等優(yōu)勢(shì),肛門功能能得到更好的保護(hù),而在腫瘤切緣及淋巴結(jié)清掃數(shù)目方面,兩組沒(méi)有明顯差異,在局部復(fù)發(fā)率及遠(yuǎn)處轉(zhuǎn)移率、總的生存時(shí)間上也沒(méi)有顯著差異。腹腔鏡輔助低位直腸癌前切除保肛手術(shù)具有手術(shù)安全性,微創(chuàng)性及腫瘤安全性,但其長(zhǎng)期療效,仍有待大規(guī)模,多中心研究的報(bào)道。有條件的醫(yī)院對(duì)分期較早的低位直腸癌患者若切除足夠的遠(yuǎn)端切緣后仍可保留肛管和肛管括約肌以及肛提肌者,應(yīng)選擇腹腔鏡保肛手術(shù)進(jìn)行治療以提高患者生活質(zhì)量。
[Abstract]:Objective: to summarize the clinical data of patients with laparoscopic assisted anterior resection of low rectal cancer and open resection of low rectal cancer. To investigate the safety, minimally invasive and superiority of laparoscopic anterior resection of low rectal cancer. Methods: from January 2009 to September 2014, 33 patients with low rectal cancer underwent laparoscopically assisted anus preservation surgery and 39 patients with low rectal cancer who underwent anus preservation surgery at the same time, from January 2009 to September 2014 in the first affiliated Hospital of Dalian Medical University. The patients were divided into two groups: laparoscopic group and laparotomy group. The operative time, blood loss, postoperative recovery (postoperative exhaust time, postoperative defecation time, postoperative hospitalization time, number of times of analgesic administration, postoperative complications) were observed in the two groups. Postoperative pathology (upper and lower incised margin, lymph node clearance, anal function half a year after operation, local recurrence rate, distant metastasis rate, survival time after operation were compared. Results the anus was retained in all the 72 patients without prophylactic ileostomy. The operative time of laparoscopy group and laparotomy group were 229min and 161 min, respectively. The amount of bleeding during operation was 36ml and 57 ml, respectively. The difference was statistically significant. The postoperative exhaust time was 3 days and 4 days, defecation time was 9 days and 7 days, postoperative average hospitalization time was 13 days and 18 days, and the average number of times of postoperative analgesic administration was 1.5 and 2.7 times. The scores of Wexner constipation were 13 points and 14 points respectively in six months after operation, and there was statistical difference between the laparoscopic group and the laparotomy group in the upper and lower incisors, the average length of the lower incisor was 3.5cm and 2.9 cm, respectively, there was statistical difference between the laparoscopic group and the laparotomy group. The number of lymph node dissection was 16 and 13, there was no statistical difference. The incidence of postoperative complications in the laparoscopy group and the open group were 15.1g / 33) and 35.9B / 14 / 39, respectively. The incidence of postoperative complications in the laparoscopic group was significantly lower than that in the open group (P < 0.05), and the difference was statistically significant. The local recurrence rates of the two groups were 6.0% and 7.7%, the distant metastasis rates were 9.1% and 12.8%, respectively, and the average survival time of the laparoscopic group and the open group were 45.7 months and 54.5 months, respectively. Conclusion: laparoscopic anus preserving surgery for low rectal cancer has the advantages of less bleeding, faster recovery, less postoperative complications and better protection of anal function. However, there was no significant difference in the number of tumor margin and lymph node dissection between the two groups, and there was no significant difference in local recurrence rate, distant metastasis rate and total survival time between the two groups. Laparoscopic assisted anus preserving surgery for low rectal cancer is safe, minimally invasive and safe. However, the long-term efficacy of laparoscopically assisted anterior resection of low rectal cancer remains to be reported in large scale and multicenter studies. In order to improve the quality of life of patients with lower rectal cancer patients with lower rectal cancer in early stage who can retain anal canal anal sphincter and levator muscle after resection of enough distal margin laparoscopic anal preservation surgery should be selected to improve the quality of life.
【學(xué)位授予單位】：大連醫(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)】：R735.37

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