经脐单孔腹腔镜乙状结肠癌根治术安全性及近期疗效分析

The safety and short-term therapeutic effect of transumbilical single-incision laparoscopic radical resection for sigmoid colon cancer

目的:评价经脐单孔腹腔镜乙状结肠癌根治术的可行性及安全性。方法:回顾分析2010年3月至2010年7月7例经脐单切口腹腔镜乙状结肠癌根治术与17例常规腹腔镜根治术的临床资料,对比分析两组患者手术安全性、术后恢复情况、并发症及术后近期随访结果。结果:7例单孔手术均获成功,无一例中转手术。手术时间平均(64.2±26.3)min,术中出血量平均(20.1±3.4)ml,切口长度平均(2.2±1.3)cm,平均清扫淋巴结(13.2±3.3)枚,术后患者无需镇痛,肛门排气时间平均(1.2±0.6)d,下床活动时间平均(1.5±0.4)d,术后平均住院(5.8±3.2)d。1例患者术后4 d出现切口感染,予以换药治愈。术后随访7～12个月,平均8.8个月,无复发、转移。与常规腹腔镜结肠癌根治术相比,单孔组切口小(P<0.05),手术时间较长(P<0.05)。结论:经脐单切口多通道腹腔镜结肠癌根治术安全、可行,具有患者创伤小、瘢痕小等优点,但技术要求较高。

Objective：To evaluate the feasibility and safety of transumbilical single-incision laparoscopic radical resection for sigmoid colon cancer.Methods：Clinical data of 24 patients from Mar.2010 to Jul.2010 were analyzed retrospectively.Seven patients underwent single-incision laparoscopic radical resection for sigmoid colon cancer,and 17 patients received conventional laparoscopic surgery.The operative safety,postoperative recovery,complications and postoperative short-term follow-up outcome of the 2 groups were comparatively analyzed.Results：Seven patients were treated successfully without open conversion.Mean operation time was（64.2±26.3） min.Mean blood loss was（20.1±3.4） ml.Mean length of incision was（2.2 ± 1.3） cm.Number of resected lymph nodes was（13.2 ± 3.3）.Patients did not request postoperative analgesia.Postoperative exhaust time was（1.2 ± 0.6） d.Mean ambulation time was（1.5 ± 0.4） d.Mean postoperative hospital stay was（5.8±3.2） d.One patient suffered wound infection on postoperative day 4 which was cured by dressing change.Postoperative follow-up time was 7-12 months with a mean of 8.8 months.No tumor recurrence and metastasis was identified.Compared with conventional laparoscopic surgery,single-incision surgery had smaller incisions and longer operation time（P0.05）.There was no significant difference between the two groups on other aspects.Conclusions：Transumbilical single-incision multi-channel laparoscopic radical resection for sigmoid colon cancer is feasible and safe.It is associated with less trauma and better cosmetic performance,but it consumes more operation time and requires higher technique level.