悬吊式与气腹腹腔镜手术治疗老年结直肠癌的对比研究

The comparative study between gasless laparoscopic surgery with abdominal wall lifting and traditional laparoscopic surgery for colorectal cancer in aged patients

目的:对比分析悬吊式腹腔镜手术与传统腹腔镜手术治疗老年结直肠癌的可行性及临床疗效。方法:回顾分析2010年6月至2012年6月为40例老年患者行腹腔镜结直肠癌手术的临床资料,分别采用悬吊式免气腹法(悬吊组,n=20)及气腹法(气腹组,n=20),对比分析两组患者手术时间、出血量、淋巴结清扫数量、术后排气时间、术后疼痛评分、术中意外损伤、术后并发症情况。结果:37例成功施行腹腔镜手术,气腹组中转1例,悬吊组中转2例。术中两组各有1例损伤输尿管;术后悬吊组发生阴道直肠漏1例,两组各有1例出现吻合口漏。两组患者手术时间、术中出血量、清除淋巴结数量、术后排气时间、术后疼痛评分及并发症情况差异均无统计学意义(P>0.05)。结论:免气腹悬吊技术应用于腹腔镜结直肠手术是安全、可行的,术中无需CO2气腹,无气腹相关并发症发生,适宜心肺功能较差及老年患者。

Objective：To compare and analyze the effect of gasless laparoscopic surgery with abdominal wall lifting and traditional laparoscopic surgery for colorectal cancer in aged patients.Methods：Forty aged patients with colorectal cancer underwent either gasless laparoscopic surgery with abdominal wall lifting（n=20,gasless group） or traditional laparoscopic surgery（n=20,pneumoperitoneum group） from Jun.2010 to Jun.2012.The operating time,blood loss,harvested lymph nodes,intraoperative unexpected injury,postoperative exhaust time,complications and pain score were compared between groups.Results：Thirty-seven operations were successfully performed,and 1 case was converted to open surgery in pneumoperitoneum group and 2 in gasless group.Each group had 1 case of ureteral injury and 1 case of anastomotic stoma fistula.And 1 case of postoperative vagina-rectum fistula was observed in gasless group.No significant difference was observed in the operating time,blood loss,total harvested lymph nodes,postoperative exhaust time,complications or pain score between the 2 groups（P＆gt;0.05）.Conclusions：Gasless laparoscopic operations for colorectal cancer with abdominal wall lifting are safe and feasible.It is better than traditional laparoscopic operations in aged patients and those with poor cardio-pulmonary function with advantages of no pneumoperitoneum complications.