本文選題：直腸癌 + 腹腔鏡��； 參考：《青海大學》2017年碩士論文

【摘要】：目的:對比腹膜外隧道式造口和腹膜內經(jīng)腹腔造口二者在一般手術并發(fā)癥、術后恢復和造口相關并發(fā)癥上是否存在差異,討論腹膜外造口的應用價值。方法:記錄2015年12月至2016年12月就診于青海大學附屬醫(yī)院胃腸腫瘤外科及腹部腔鏡外科行腹腔鏡輔助腹會陰聯(lián)合直腸癌根治術的患者,選入腹膜外隧道式造口組35例為研究組,腹膜內經(jīng)腹腔造口組30例為對照組。收集兩組的相關臨床資料進行對比分析。結果:一般情況的差異在兩組間無統(tǒng)計學意義(P0.05);術中情況:研究組和對照組在手術時間(220.09±27.04和212.47±20.45,P0.05)、造口時間(23.43±2.67min和22.17±3.02,P0.05)和手術出血量(183.71±85.89ml和172.33±76.77,P0.05)的差異均無統(tǒng)計學意義。術后恢復:研究組和對照組在術后排氣時間(中位數(shù)2d和3d,P0.05)和術后住院天數(shù)(14.71±6.91d和17.33±4.40d,P0.05)上的差異無統(tǒng)計學意義,而在術后造口排便時間(中位數(shù)2d和3d,P0.05)和首次進食時間(中位數(shù)2d和3d,P0.05)上差異有統(tǒng)計學意義。一般并發(fā)癥:研究組6例,對照組7例,差異無統(tǒng)計學意義(P0.05)。造口并發(fā)癥:研究組和對照組分別為9例和15例,兩組差異在兩組間有統(tǒng)計學意義(P0.05)。造口水腫研究組和對照組分別出現(xiàn)7例和1例,造口水腫兩組患者的發(fā)生情況的差異有統(tǒng)計學意義(P0.05)。結論:腹膜外隧道式乙狀結腸造口相較腹膜內經(jīng)腹腔造口有降低造口相關并發(fā)癥優(yōu)勢。術后消化功能恢復方面,腹膜外隧道式乙狀結腸造口術后排便時間和進食時間早于腹膜內經(jīng)腹腔造口。但是腹膜外隧道式乙狀結腸造口患者造口水腫發(fā)生率較腹膜內乙狀結腸造口患者高。
[Abstract]:Objective: to compare the difference between extraperitoneal tunnel orifice and intraperitoneal orifice in general complications, postoperative recovery and postoperative complications, and to discuss the application value of extraperitoneal orifice. Methods: from December 2015 to December 2016, 35 patients with gastroenteric neoplasms and abdominal endoscopic surgery underwent laparoscopically assisted abdominal perineum combined rectal cancer resection, and 35 patients were selected as the study group. The 30 cases in the intraperitoneal orifice group were the control group. The clinical data of the two groups were collected and compared. Results: there was no significant difference in general conditions between the two groups (P 0.05), but there was no significant difference between the two groups in the operative time (220.09 鹵27.04 and 212.47 鹵20.45), the operative time (23.43 鹵2.67min) and the operative bleeding volume (183.71 鹵85.89ml and 172.33 鹵76.77 P0.05). Postoperative recovery: there was no significant difference between the study group and the control group in the postoperative exhaust time (median 2 d and 3 d P0.05) and the postoperative hospitalization days (14.71 鹵6.91 d and 17.33 鹵4.40 d P0.05). There was a significant difference in postoperative fecal time (median 2 d and 3 d P 0 05) and first feeding time (median 2 d and 3 d P 0 05). General complications: 6 cases in the study group and 7 cases in the control group, the difference was not statistically significant (P 0.05). Complications of anastomosis: 9 cases in the study group and 15 cases in the control group, the difference between the two groups was statistically significant (P 0.05). There were 7 cases and 1 case of ostomy edema in the study group and the control group respectively. There was significant difference in the occurrence of ostomy edema between the two groups (P 0.05). Conclusion: Extraperitoneal tunnel sigmoidostomy is superior to intraperitoneal orifice in reducing the complications associated with colostomy. The time of defecation and feeding after extraperitoneal tunnel sigmoidostomy was earlier than that of intraperitoneal stomy. However, the incidence of edema in patients with extraperitoneal tunnel sigmoidostomy was higher than that in patients with intraperitoneal sigmoidostomy.
【學位授予單位】：青海大學
【學位級別】：碩士
【學位授予年份】：2017
【分類號】：R735.37

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