本文選題：結(jié)直腸癌 + 腹腔鏡��； 參考：《重慶醫(yī)科大學(xué)》2017年碩士論文

【摘要】：目的 研究年齡大于65歲的老年結(jié)直腸癌患者接受腹腔鏡中轉(zhuǎn)開腹手術(shù)后的影響。方法 收集我院胃腸外科自2013年至2015年期間年齡大于65歲明確診斷為結(jié)直腸癌,符合本研究納入標(biāo)準(zhǔn)及排除標(biāo)準(zhǔn)的手術(shù)患者,并根據(jù)患者最終施行手術(shù)方式將病人分為3組:腹腔鏡組、腹腔鏡中轉(zhuǎn)開腹組,開腹組,所有手術(shù)均由我科高年資醫(yī)師主刀,術(shù)后分析腹腔鏡中轉(zhuǎn)開腹手術(shù)原因、比較3組患者短期結(jié)局,將有關(guān)數(shù)據(jù)進(jìn)行SPSS17.0分析。相應(yīng)的觀察指標(biāo)包括:出血量、手術(shù)時(shí)間、術(shù)后住院時(shí)間、術(shù)后并發(fā)癥(切口并發(fā)癥、肺部并發(fā)癥、吻合口并發(fā)癥、2次手術(shù)、腸梗阻、其他并發(fā)癥)。結(jié)果 符合納入標(biāo)準(zhǔn)及排除標(biāo)準(zhǔn)的共760例,其中共518例順利完成腹腔鏡手術(shù),42例腹腔鏡中轉(zhuǎn)開腹手術(shù),200例開腹手術(shù),中轉(zhuǎn)率為7.5%。中轉(zhuǎn)原因主要為腫瘤局部分期晚與周圍組織粘連(38%)、瘤體大、位置固定(24%)�；颊咝g(shù)前一般資料相比無明顯差異(P0.05),據(jù)腫瘤位置最終選擇的手術(shù)種類相比,腹腔鏡組與中轉(zhuǎn)開腹組存在差異(P0.05),腹腔鏡組手術(shù)時(shí)間及術(shù)中出血量較中轉(zhuǎn)組少(P0.05),開腹組手術(shù)時(shí)間短于中轉(zhuǎn)組,而出血量與中轉(zhuǎn)組無差異(P0.05)。術(shù)后并發(fā)癥方面相比中轉(zhuǎn)組切口并發(fā)癥、肺部并發(fā)癥發(fā)生率較腹腔鏡組高,術(shù)中出血量及手術(shù)時(shí)間較腹腔鏡組多(P0.05);而吻合口、心腦血管并發(fā)癥、術(shù)后腸梗阻及2次手術(shù)等發(fā)生率沒有明顯差異(P0.05)。中轉(zhuǎn)組與開腹組相比各并發(fā)癥發(fā)生率方面均無明顯差異。結(jié)論 腹腔鏡結(jié)直腸癌手術(shù)對(duì)患者損傷更小、術(shù)后并發(fā)癥更少,腹腔鏡結(jié)直腸癌手術(shù)對(duì)老年患者是安全有效的,同時(shí)腹腔鏡中轉(zhuǎn)開腹手術(shù)與開腹手術(shù)相比并沒給患者帶來更壞的短期結(jié)局。
[Abstract]:Objective to study the effect of laparoscopy on colorectal cancer patients over 65 years old. Methods from 2013 to 2015, patients with colorectal cancer diagnosed by gastrointestinal surgery over 65 years old, who met the criteria of inclusion and exclusion of this study, were collected. The patients were divided into three groups according to the final operation mode: laparoscopy group, laparoscopy conversion group, all the operations were performed by our senior physician. The reasons of laparoscopic conversion to open surgery were analyzed after operation. The short-term outcomes of the three groups were compared and the data were analyzed by SPSS17.0. The corresponding indexes included: bleeding volume, operation time, postoperative hospitalization time, postoperative complications (incision complications, lung complications, anastomotic complications), intestinal obstruction, other complications. Results A total of 760 cases conformed to the criteria of inclusion and exclusion, of which 518 cases were successfully completed laparoscopic surgery, 42 cases were converted to laparotomy in 200 cases, the conversion rate was 7.5%. The main causes of the transfer were local stage late adhesion with the surrounding tissue and 38% of the tumor, the tumor was large, fixed at 24% of the tumor. There was no significant difference in the general data of the patients before operation (P 0.05). There was significant difference between the laparoscopy group and the conversion group (P 0.05). The operative time and blood loss in the laparoscopy group were less than those in the transfer group. The operative time in the laparotomy group was shorter than that in the transit group, but there was no difference in the bleeding volume between the laparoscopy group and the transit group. The incidence of postoperative complications was higher than that of laparoscopy group, and the amount of blood loss and operation time was more than that of laparoscopy group (P 0.05), while anastomosis, cardio-cerebrovascular complications, anastomosis, cardiovascular and cerebrovascular complications were more common than those in laparoscopy group. There was no significant difference in the incidence of intestinal obstruction and two operations after operation (P 0.05). There was no significant difference in the incidence of complications between the transfer group and the open group. Conclusion Laparoscopic colorectal cancer surgery has less injury and less postoperative complications. Laparoscopic colorectal cancer surgery is safe and effective for elderly patients. At the same time, laparoscopic conversion to open surgery did not bring a worse short-term outcome than open surgery.
【學(xué)位授予單位】：重慶醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R735.34

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