无气腹悬吊式腹腔镜手术在大肠肿瘤治疗中的应用

Application of Suspended Gasless Laparoscopy in Colorectal Tumor Surgery

[目的]对比悬吊式腹腔镜(悬吊组)与气腹腹腔镜(气腹组)在结直肠肿瘤手术中的应用效果。[方法]回顾性调查2005年7月14日～2008年7月10日接受腹腔镜结直肠癌手术治疗病人42例,其中悬吊组20例,气腹组22例,比较两组的手术时间、术中出血量、清除淋巴结数、术后排气时间。[结果]手术时间:悬吊组100～310min,平均205.5±14.37min;气腹组90～480min,平均244.77±23.65min(P=0.174)。术中出血量:悬吊组100～260ml,平均160.9±12.28ml;气腹组20～700ml,平均218.41±35.92ml(P=0.153)。清除淋巴结数:悬吊组5～25枚,平均15.2±1.16枚;气腹组6～44枚,平均17.05±1.9枚(P=0.424)。术后排气时间:悬吊组26～46h,平均35.7±1.48h;气腹组18～48h,平均32.55±1.86h(P=0.198)。气腹组术中损伤输尿管1例,中转开腹2例;悬吊组术后阴道直肠瘘1例;两组各有1例直肠癌术后出现吻合口瘘。[结论]悬吊式腹腔镜手术消除了CO2气腹对血液动力学的影响,可能成为心肺功能较差及老年病人的一种术式选择。

[Purpose] To compare the effect of suspended gasless laparoscopic surgery and gas laparoscopic surgery for colorectal tumor. [Methodsl Forty-two cases with colorectal cancer undergoing laparoscopic surgery from July 14, 2005 to July 10, 2008 was retrospectively analyzed. The patients were divided into two groups： gasless laparoscopic group 20 cases and gaslaparoscopic group 22 cases. Operating time, bleeding volume, number of lymph node excised and the time of bowel movement were compared between the two groups. [ Results ] In gasless group and gas group, the operatingtime （mean） was 100-310min （205.5±14.37min）, 90-480min （244.77± 23.65min）（P=0.174）; bleeding volume, 100-260ml（160.9±12.28ml）, 20-700ml（218.41±35.92ml） （P=0.153）; number of lymph node excised, 5-25（15.2±1.16）, 6-44（17.05±1.9）（P=0.424）; the time of bowel movement, 26-46h（35.7±1.48h）, 18-48h（32.55±1.86h）（P=0.198）. One case with urethra injury and 2 cases conversion to open operations occurred in gas laparoscopic group. One case with rectal-vagina fistula occurred in gasless laparoscopic group. Each ease with anastomotic stoma fistula occurred in the two groups. [Conclusions] Abdominal wall lifting laparoscopy eliminates the influence of CO2 to the blood dynamics. So it may become a choice for the elderly and cardio respiratory dysfunction patients.