腹腔镜结直肠癌切除术手术相关中转开腹的危险因素分析

Analysis of risk factors for conversion of laparoscopic resection to open surgery of colorectal cancer

目的评估腹腔镜结直肠癌切除术手术相关中转开腹的危险因素。方法回顾性分析我院自2002年1月至2012年1月共813例腹腔镜结直肠切除术的病例资料,其中中转开腹的患者68例。比较中转开腹和腹腔镜组两组患者的一般临床资料、围手术期数据、短期临床疗效。结果手术中转开腹率为8.3%,IV期疾病、T4期肿瘤、肿瘤长度>5 cm,手术术式、腹部手术史均为中转开腹的独立危险因素。在手术相关数据方面,虽然手术时间未开腹组较开腹组略长,但开腹组在术中失血量(262.4 m L vs.104.3 m L,P<0.001)和输血量(126.8 ml VS 17.8 m L P<0.001)上,均明显高于未开腹组。在术后短期临床疗效方面,两组在恢复软食时间(3.82 vs 4.63天,P<0.001),肛门开始排气时间(2.95 vs.3.41天,P<0.001),下床活动时间(2.37 vs.3.14天,P<0.001),住院时间(18.9 vs.22.4天,P<0.001)上均具有明显的统计学差异。结论 T4期肿瘤、IV期疾病分期、腹部手术史、肿瘤直径大于5 cm和手术术式都是影响术中中转开腹的独立因素。

Objective To evaluate the risk factors for conversion of laparoscopic to open surgery for colorectal cancer. Methods A retrospective analysis of our hospital from January 2002 to January 2012, a total of 813 cases of laparoscopic colorectal resection were retrospectively analyzed,including 68 patients converted to open surgery. The clinical baseline data, perioperative data, shortterm clinical efficacy were compared between laparoscopic and conversion groups. Results The rate of conversion to open surgery was 8.3%（68 patients）. Stage IV, T4 stage, tumor length 〉5 cm, surgical procedures, abdominal surgery history were significantly associated with the risk of conversion to open surgery. In terms of surgery-related data,although laparoscopic group had slightly longer operation time,conversion group had more blood loss during surgery（262.4 ml vs 104.3 ml, P〈0.001） and blood transfusion（126.8 ml vs 17.8 ml, P〈0.001）. In terms of short-term clinical efficacy, the time to soft diet（3.82 vs 4.63 day, P〈0.001）, time to flatus（2.95 vs 3.41 day,P〈0.001）, time to ambulation（2.37 vs 3.14 day, P〈0.001）, and length of hospital stay（18.9 vs 22.4 day, P〈0.001） had significant differences between the two groups. Conclusion T4 tumor stage, stage IV, abdominal surgery history, tumor size 5 cm and surgical procedures are independent factors for conversion to open surgery.