王新, 马永勋, 张晓农. 单孔腹腔镜乙状结肠及直肠癌根治术可行性及效果研究[J]. 蚌埠医科大学学报, 2018, 43(7): 868-873. DOI: 10.13898/j.cnki.issn.1000-2200.2018.07.008
    引用本文: 王新, 马永勋, 张晓农. 单孔腹腔镜乙状结肠及直肠癌根治术可行性及效果研究[J]. 蚌埠医科大学学报, 2018, 43(7): 868-873. DOI: 10.13898/j.cnki.issn.1000-2200.2018.07.008
    WANG Xin, MA Yong-xun, ZHANG Xiao-nong. Study on the feasibility and effect of single hole laparoscopy in the radical operation of sigmoid colon and rectal cancer[J]. Journal of Bengbu Medical University, 2018, 43(7): 868-873. DOI: 10.13898/j.cnki.issn.1000-2200.2018.07.008
    Citation: WANG Xin, MA Yong-xun, ZHANG Xiao-nong. Study on the feasibility and effect of single hole laparoscopy in the radical operation of sigmoid colon and rectal cancer[J]. Journal of Bengbu Medical University, 2018, 43(7): 868-873. DOI: 10.13898/j.cnki.issn.1000-2200.2018.07.008

    单孔腹腔镜乙状结肠及直肠癌根治术可行性及效果研究

    Study on the feasibility and effect of single hole laparoscopy in the radical operation of sigmoid colon and rectal cancer

    • 摘要: 目的:对比单孔和多孔腹腔镜乙状结肠及直肠癌根治术的效果,评估单孔腹腔镜手术在乙状结肠和直肠癌根治术中的可行性。方法:选取2014年1月至2016年1月结直肠癌病人120例,采用随机数字表法将其分为2组,每组60例,单孔组行单孔腹腔镜结直肠癌根治术,多孔组行常规多孔腹腔镜结直肠癌根治术,对比2组病人术中情况、术后恢复情况、近远期并发症及生存质量情况。结果:2组手术时间、出血量、肿瘤体积、远切缘距肿瘤下缘距离、淋巴结清扫数和阳性淋巴结数方面差异均无统计学意义(P > 0.05);而单孔组切口长度明显短于多孔组(P < 0.01);单孔组近切缘距肿瘤上缘距离明显大于多孔组(P < 0.01)。单孔组术后肛门自动排气、进流质食物、进固体食物、首次排便时间均明显短于多孔组(P < 0.01),术后2组病人胃动素水平较术前均有所下降(P < 0.05和P<0.01),且单孔组胃动素水平明显高于多孔组(P < 0.01);单孔组术后疼痛视觉模拟评分明显小于多孔组,美容指数明显高于多孔组,住院时间明显短于多孔组(P < 0.01)。单孔组病人术后切口感染、切口裂开、肺部感染、尿路感染、吻合口瘘或出血等近期并发症总发生率为3.33%,低于多孔组的13.33%(P < 0.05),2组复发、远处转移、死亡等远期并发症发生率比较差异无统计学意义(P > 0.05)。单孔组出院时、随访各时点胃肠道生活质量指数(GIQLI)评分均高于多孔组(P < 0.05~P < 0.01)。2组手术前后各时间点GIQLI评分差异均有统计学意义(P < 0.01),出院时、随访各时点胃肠道生活质量指数(GIQLI)评分均显著高于术前(P < 0.01)。结论:单孔腹腔镜结直肠癌根治术根治效果确切、术后恢复快、美容效果佳,且预后良好,可明显提高病人生存质量,可作为首选手术方案之一。

       

      Abstract: Objective: To compare the effects between single hole and multi-hole laparoscopy in the radical operation of sigmoid colon and rectal cancer,and assess the feasibility of single hole laparoscopy.Methods: One hundred and twenty colorectal cancer patients during January 2014 to January 2016 were randomly divided into the single hole group and mutli-hole group using the random number table method(60 cases each group).The single hole group and mutli-hole group were treated with single hole and mutli-hole laparoscopic colorectal cancer radical operation,respectively.The intraoperative situation,postoperative recovery,complication and quality of life between two groups were compared.Results: The differences of operation time,amount of bleeding,tumor volume,distance from distal incision margin to the low margin of tumor,and number of lymph node dissection and positive lymph nodes between two groups were not statistically significant(P>0.05).The length of incision in single hole group was significantly shorter than that in multi-hole group(P<0.01).The distance from the proximal cut edge to the upper margin of tumor in single hole group was significantly longer than that in multi-hole group(P<0.01).The anus automatical exhausts time,eating liquid food time,eating solid food time and first defecating time in single hole group were significantly shorter than those in multi-hole group(P<0.01).The levels of motilin in two groups after operation decreased compared before operation(P<0.05 and P<0.01),and which in single hole group was significantly higher than that in multi-hole group(P<0.01).The postoperative VAS score,beauty index and length of stay in single hole group were significantly smaller,higher and shorter than those in multi-hole group,respectively(P<0.01).The incidence rate of early complications(including incisional infection,incision disruption,pulmonary infection,urinary tract infection and anastomotic fistula or bleeding)(3.33%) in single hole group was less than that in multi-hole group(13.33%)(P<0.05).The difference of the incidence rate of the long-term complications(including recurrence,distant metastasis and death) between two groups was not statistically significant(P>0.05).The GIQLI scores in single hole group at discharge and during the following up in single hole group were higher than that in multi-hole group(P<0.05 to P<0.01).The difference of the GIQLI scores in two groups between before and after operation were statistically significant(P<0.01),and the GIQLI scores in two groups at discharge and during the following up were significantly higher than that before operation(P<0.01).Conclusions: The single hole laparoscopy in the radical operation of sigmoid colon and rectal cancer is good effect,quick recovery,good cosmetic result,and good prognosis,which can significantly improve the quality of life of patients,and be used as one of the preferred surgical plan.

       

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