腹腔镜直肠手术中转开腹的临床评价

Evaluation on convertion to open surgery in laparoscopic rectal resection

目的分析腹腔镜直肠癌手术中转开腹对患者的影响。方法回顾性分析2007年6月至2010年5月136例腹腔镜直肠癌手术,其中中转开腹(CON)41例,与同期开腹直肠癌手术(OPN)56例进行比较,总结中转开腹的原因及阶段,分析手术时间、术中出血量、术后肠功能恢复时间、术后住院时间、手术并发症等情况。结果盆腔狭窄导致直肠切断困难成为腹腔镜直肠癌手术中转开腹的首要原因;CON组同OPN组相比,术中出血量明显减少(P=0.042),而在手术时间、术后住院时间、术后肠功能恢复时间、手术并发症、留置导尿管时间等方面,两组之间差异无统计学意义(P>0.05)。结论腹腔镜直肠癌手术中转开腹并不一定能给患者带来不利影响,反而能发挥部分腹腔镜手术的微创优点。

Objective To investigate the impact of convertion to open surgery in laparoscopic rectal resection. Methods From June 2007 to March 2010, 136 patients with rectal cancer received laparoscopic rectal resection, among which 41cases were converted to open surgery, the data about operation time,intraoperative blood loss, hospitalization time, recovery time of bowel movement and urinary function, and complications were analyzed compared with 56 cases of open rectal resection. Results The narrow pelvic space became the main reason of convertion to open surgery in laparoscopic rectal resection.There no differences between CON and OPN about operation time,hospitalization time,recovery time of bowel movement and urinary function,and complications （ P 〉0.05）. The intraoperative blood loss of laparoscopic group was obviously less than that in open group （ P = 0.042 ）. Conclusions Conversion may not necessarily be associated with appreciably poorer resuhs and would still provide to the majority of the patients the potential benefits of a laparoscopic approach.