3D腹腔镜辅助与传统开腹左结肠癌根治术围术期指标比较

Comparison of perioperative indicators between 3D laparoscopic-assisted radical surgery and conventional open radical surgery for left colon cancer

  • 摘要: 目的 比较3D腹腔镜辅助左结肠癌根治术与传统开腹左结肠癌根治术的安全性与近期临床疗效。 方法 回顾性分析2015年11月- 2017年11月解放军总医院普通外科行左结肠癌根治术患者124例的临床资料。观察组61例,行3D腹腔镜辅助左结肠癌根治术;对照组63例,行传统开腹左结肠癌根治术,比较两组的手术时间、留置导尿时间、首次下床时间、进食流质食物时间、手术出血量、住院时间、淋巴结清扫数目等近期临床疗效指标。 结果 观察组与对照组性别、年龄、体质量指数(body mass index,BMI)、肿瘤位置、肿瘤大小、术前有无梗阻等基线资料的差异无统计学意义(P均> 0.05)。与对照组相比,观察组手术时间短(85.3±10.1) min vs (112.4±12.3) min,P=0.000,手术出血量少(88.7±15.6)ml vs(115.6±16.6) ml,P=0.001,切口长度短(7.4±2.9) cm vs (15.1±3.7) cm,(P=0.000),首次下床活动时间早(24.8±6.2) h vs(36.2±7.4) h,P=0.001,留置导尿时间短(2.3±1.1) d vs (3.5±1.7) d,P=0.002,进食流质食物时间早(47.9±7.3) h vs(55.4±6.5) h,P=0.001,住院时间短(7.1±2.6) d vs (10.4±2.7) d,P=0.001。淋巴结清扫数目观察组(15.4±2.7)枚,对照组(14.8±2.9)枚,差异无统计学意义(P=0.242)。观察组出现3例吻合口瘘,经过腹腔冲洗等保守治疗2周后治愈出院;1例发生肠梗阻,经过营养支持等对症处理后治愈出院。对照组出现3例吻合口瘘,经过腹腔冲洗等保守治疗2周后治愈出院;2例发生肠梗阻,经过对症处理后治愈出院。两组术后并发症发生率差异无统计学意义(P=0.914)。 结论 相较于传统开腹左结肠癌根治术,3D腹腔镜辅助左结肠癌根治术具有创伤小、恢复快的优点,安全可行。

     

    Abstract: Objective To compare the safety and short-term clinical outcomes of 3D laparoscopy versus conventional open radical surgery in the treatment of left colon cancer. Methods Clinical data about 124 patients with left colon cancer who received radical surgery in Chinese PLA General Hospital from November 2015 to November 2017 were retrospectively analyzed. Patients in observation group (n=61) received 3D laparoscopy, while the control group (n=63) with conventional open radical surgery.The operating time, time of retention catheterization, time to ambulation, time to take liquid food, intraoperative blood loss, hospitalization and number of lymph node dissected were compared between the two groups. Results There was no significant difference in baseline data between two groups, such as age, sex, body mass index (BMI), tumor location, tumor size, preoperative obstruction and so on (all P< 0.05). There were significant differences in operating time (85.3±10.1) min vs (112.4±12.3) min, P=0.000, amount of operative bleeding (88.7±15.6) ml vs (115.6±16.6) ml, P=0.001, incisive length (7.4±2.9) cm vs(15.1±3.7) cm, P=0.000, fi rst time to get out of bed (24.8±6.2) h vs (36.2±7.4) h, P=0.001, time of indwelling urinary catheter(2.3±1.1) d vs (3.5±1.7) d, P=0.002, time for taking liquid food (47.9±7.3) h vs (55.4±6.5) h, P=0.001, and hospitalization time (7.1±2.6) d vs (10.4±2.7) d, P=0.001. However, no significant difference was found in number of harvested lymph nodes(15.4±2.7) vs (14.8±2.9), P=0.242. Anastomotic fi stula occurred in 3 cases in the observation group, and they were cured and discharged after 2 weeks of conservative treatment such as peritoneal fl ushing. One patient with intestinal obstruction was cured and discharged after symptomatic treatment including nutritional support. In the control group, 3 cases of anastomotic fi stula were cured and discharged after 2 weeks of conservative treatment such as peritoneal fl ushing, 2 patients with intestinal obstruction were cured and discharged after symptomatic treatment. There was no significant difference in postoperative complications between two groups(P=0.914). Conclusion Compared with traditional open radical resection, 3D laparoscopic assisted treatment for left colon cancer is safe and feasible, and it also has the advantages of quick recovery after surgery.

     

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