【摘要】：研究背景:腹腔鏡手術(shù)治療結(jié)直腸癌療效確切,且有“手術(shù)視野清晰、創(chuàng)傷小、術(shù)后恢復(fù)快”等優(yōu)點,但其并不能成為治療結(jié)直腸癌的標(biāo)準(zhǔn)化、單一化手術(shù)模式。原因可能是腹腔鏡手術(shù)主要是根據(jù)腹腔鏡顯像信息如腸管體積改變、腸管漿膜層受侵犯、局部淋巴結(jié)腫大等情況判斷病情,而缺乏“手”的精細(xì)觸覺。對于大部分腫瘤體積較小的結(jié)直腸癌患者,術(shù)中難以準(zhǔn)確判斷腫瘤位置,也就難以確定精準(zhǔn)的手術(shù)切除范圍,可能會造成“治療不足”或“治療過度”的后果。本研究通過比較腹腔鏡聯(lián)合術(shù)中腸鏡手術(shù)、單純腹腔鏡手術(shù)治療結(jié)直腸癌的臨床療效,旨在探討腹腔鏡聯(lián)合術(shù)中腸鏡治療結(jié)直腸癌的安全性、有效性。材料和方法:回顧性分析2011年1月至2015年12月貴港市人民醫(yī)院胃腸外科收治的186例結(jié)直腸癌患者的臨床資料。其中腹腔鏡聯(lián)合術(shù)中腸鏡治療(聯(lián)合組)84例,腹腔鏡治療(腔鏡組)102例。兩組患者的臨床術(shù)前資料有可比性。比較2組術(shù)中出血量、手術(shù)時間、胃腸功能恢復(fù)時間、術(shù)后住院天數(shù)、平均切緣、平均淋巴結(jié)清掃數(shù)目、二次手術(shù)次數(shù)(包括術(shù)中處理吻合口、術(shù)中追加手術(shù))、并發(fā)癥情況(吻合口如出血、漏及心肺腦并發(fā)癥)、出院后隨訪情況等,以探討腹腔鏡聯(lián)合術(shù)中腸鏡治療結(jié)直腸癌的安全性、有效性。結(jié)果:兩組手術(shù)均順利完成,2組手術(shù)時間、術(shù)中出血比較差異無統(tǒng)計學(xué)意義(t值分別為2.518、1.924,P值分別為0.057、0.077)。聯(lián)合組吻合口術(shù)中追加縫扎10例,其中吻合不滿意7例,出血3例;腔鏡組4例(均為出血),比較差異有統(tǒng)計學(xué)意義(χ2=4.218,P=0.040)。腔鏡組術(shù)中追加手術(shù)(切緣不足,同期追加擴(kuò)大切除范圍)9例,聯(lián)合組0例,比較有統(tǒng)計學(xué)意義(χ2=7.789,P=0.005)。2組術(shù)后首次肛門排氣、排便時間、進(jìn)食時間以及術(shù)后住院時間比較差異無統(tǒng)計學(xué)意義(t值分別為1.482、1.726、1.653、2.451,P值分別為0.327、0.518、0.483、0.752)。吻合口并發(fā)癥:聯(lián)合組吻合口漏2例(2.38%),均保守治愈;腔鏡組吻合口漏7例、出血3例,共10例(9.80%),其中4例經(jīng)2次手術(shù)治愈,兩組吻合口并發(fā)癥發(fā)生率比較差異有統(tǒng)計學(xué)意義(χ2=4.205,P=0.040)。聯(lián)合組術(shù)后感染12例(腹腔感染2例、切口感染5例、肺部感染2例、尿路感染3例),腔鏡組13例(腹腔感染2例、切口感染4例、肺部感染3例、尿路感染4例)比較差異無統(tǒng)計學(xué)意義(χ2=0.094,P=0.759)。標(biāo)本腫瘤學(xué)情況:兩組平均結(jié)腸標(biāo)本長度、直腸標(biāo)本長度、結(jié)腸遠(yuǎn)切緣長度、直腸遠(yuǎn)切緣長度及淋巴結(jié)數(shù)等比較差異無統(tǒng)計學(xué)意義(t值分別為2.615、1.476、0.453、1.145、0.912,P值分別為0.072、0.135、0.604、0.215、0.367);兩組切緣陽性比較差異無統(tǒng)計學(xué)意義(χ2=2.421,P=0.120)。結(jié)論:1.腹腔鏡聯(lián)合術(shù)中腸鏡治療結(jié)直腸癌是安全可行的。2.兩鏡聯(lián)合,可對病灶進(jìn)行立體觀察,兩者優(yōu)勢互補(bǔ),能夠達(dá)到“精確”的手術(shù)切除,實現(xiàn)微創(chuàng)治療的優(yōu)勢最大化,也能夠更好的體現(xiàn)“腫瘤根治原則”。
[Abstract]:Background: laparoscopic surgery is effective in the treatment of colorectal cancer, and has the advantages of "clear surgical field, less trauma and quick recovery", but it can not be used as a standardized and single surgical mode for colorectal cancer. The reason may be that laparoscopic surgery is mainly based on the information of laparoscopic imaging, such as intestinal volume changes, intestinal serous layer invasion, local lymphadenopathy and so on, but lack of "hand" fine tactile. For most colorectal cancer patients with small tumor size, it is difficult to accurately judge the location of the tumor during operation, and it is difficult to determine the exact range of surgical resection, which may lead to the consequences of "inadequate treatment" or "over-treatment". The purpose of this study was to evaluate the safety and efficacy of laparoscopy combined with intraoperative colonoscopy in the treatment of colorectal cancer. Materials and methods: the clinical data of 186 patients with colorectal cancer treated in gastrointestinal surgery department of Guigang Municipal people's Hospital from January 2011 to December 2015 were analyzed retrospectively. Among them, 84 cases were treated by laparoscopy combined with endoscopy (combined group), 102 cases were treated by laparoscopy (endoscopic group). The preoperative clinical data of the two groups were comparable. Blood loss, operation time, gastrointestinal function recovery time, postoperative hospitalization days, average incision margin, average number of lymph node dissection, number of secondary operations (including anastomotic stoma management during operation) were compared between the two groups. In order to evaluate the safety and efficacy of laparoscopy combined with endoscopy in the treatment of colorectal cancer, the complications (such as anastomotic bleeding, leakage, cardiopulmonary and cerebral complications) and follow-up after discharge were discussed in order to explore the safety and efficacy of laparoscopy combined with endoscopy in the treatment of colorectal cancer. Results: the operation time of the two groups was successfully completed and there was no significant difference in intraoperative bleeding (t = 2.518 ~ 1.924 P = 0.057 鹵0.077). In the combined group, 10 cases were sutured during anastomosis, among which 7 cases were dissatisfied with anastomosis, 3 cases were bleeding, and 4 cases (all bleeding) in the endoscopic group, the difference was statistically significant (蠂 2 + 4.218). There were 9 cases in the endoscopic group and 0 cases in the combined group. There was significant difference between the two groups (蠂 2, 7.789, P0. 005) in the first time of anal exhaust and defecation after operation in group 2, and the time of anal exhaust and defecation in the combined group was significantly higher than that in the control group (P 0. 005). There was no significant difference in feeding time and hospitalization time after operation (t = 1.482U 1.726U 1.653U 2.451g P = 0.327g 0.518 鹵0.483n 0.752, respectively). Anastomotic complications: anastomotic leakage occurred in 2 cases (2.38%) in the combined group and anastomotic leakage in 7 cases (9. 80%) in the endoscopic group and in 3 cases (9. 80%), among which 4 cases were cured by two operations. There was a significant difference in the incidence of anastomotic complications between the two groups (蠂 2. 205 P 0. 040). There were 12 cases of postoperative infection (2 cases of abdominal infection, 5 cases of incision infection, 2 cases of pulmonary infection and 3 cases of urinary tract infection) in the combined group, 13 cases in the endoscopic group (2 cases of abdominal infection, 4 cases of incision infection, 3 cases of pulmonary infection). There was no significant difference in urinary tract infection in 4 cases (蠂 2, 0.094, P < 0. 759). Oncology of specimens: the average length of colonic specimens, rectum specimens, and distal margin of colon were measured in both groups. There was no significant difference in the length of rectum distal margin and the number of lymph nodes between the two groups (t = 2.6151.476U 0.453U 1.145U 0.912P = 0.0720.135U 0.6040.2150.367), and there was no significant difference between the two groups (蠂 22.421P 0.120). Conclusion 1. Laparoscopy combined with endoscopy is a safe and feasible method for colorectal cancer. The combination of two endoscopes can make stereoscopic observation of the lesions. They complement each other, which can achieve "accurate" surgical resection, maximize the advantages of minimally invasive treatment, and better reflect the "principle of radical resection of tumor".
【學(xué)位授予單位】：廣西醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R735.34

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