超声刀在直肠癌经腹会阴联合根治性手术会阴部操作中的应用

Application of ultrasonic harmonic scalpel in perineal operation of abdominal-perineal resection for low rectal cancer

目的:探讨低位直肠癌经腹会阴联合根治术在会阴部操作中使用超声刀与使用电刀的差异。方法:2007年6月至2009年10月收治低位直肠癌患者35例,其中19例使用强生公司豪韵GEN04超声切割止血系统手术(超声刀组),另16例使用电刀作为对照(电刀组)。两组患者年龄、性别、肿瘤Dukes分期、大体类型、组织学分化程度等差异均无统计学意义。结果:所有手术均获成功。超声刀组和电刀组会阴部手术平均操作时间分别为77min和85min(P<0.05),术中平均失血量分别为43(25～61)ml和60(35～89)ml(P<0.05)。术后会阴部切口一期愈合率分别为94.74%(18/19)和68.75%(11/16)(P<0.05)。结论:低位直肠癌经腹会阴联合根治术会阴部操作时使用超声刀具有手术时间短、术中出血少、术后局部切口愈合好等优势,但费用稍昂贵,在有条件的单位及患者中值得大力推广。

Objective：To discuss the differences of the effects on operineal operation of abdominal-perineal resection for low rectal cancer between using ultrasonic harmonic scalpel（UHS）and electrotome.Methods：Thirty-five patients from Jun.2007 to Oct.2009,suffering low rectal cancer in the same surgical group,underwent radical operation,19 by GEN04 UHS（UHS group）and 16 by electrotome as control group.There was no significant difference between two groups including the factors of age,gender,tumor Dukes staging,gross morphology and degree of histological differentiation.Results：All operations were done successfully.The mean operation time of UHS group and control group were 77min and 85min,respectively（P0.05）.The mean operative blood loss was 43（25-61）ml in UHS group and 60（35-89）ml in control group（P0.05）.The first stage healing rate was 94.74% in UHS group and 68.75% in control group（P0.05）.Conclusions：In perineal operation of abdominal-perineal resection for low rectal cancer,benefits of using UHS are shorter operation time,less blood loss,better healing of incision.Although higher expenses of the operation,ultrasonic harmonic scalpel should be widely used for wealthy patients.