经腹与经肛门取标本的腹腔镜乙状结肠癌切除术的临床观察

The clinical significance of laparoscopic sigmoid cancer resection using natural orifice specimen extraction versus transabdominal specimen extraction

目的探讨经腹与经肛门取标本的腹腔镜乙状结肠癌切除术的安全性及有效性。方法选取2012年10月至2013年10月76例乙状结肠癌患者,随机分为对照组和观察组,每组38例。两组均行腹腔镜乙状结肠癌切除术,对照组给予经腹取标本,观察组经肛门取标本。比较两组患者手术指标、手术中转率及术后并发症发生情况。结果观察组手术时间明显长于对照组,肛门排气时间明显短于对照组,两组比较差异有统计学意义(P均<0.05)。两组患者术中出血量及术后住院时间比较差异均无统计学意义(P均>0.05)。对照组1例因肿瘤侵犯输尿管中转开腹手术,观察组2例因肿瘤较大改为经腹取标本。对照组伤口感染2例,泌尿系感染1例,肺炎1例;观察组腹腔感染2例,肠粘连1例。对照组与观察组患者手术中转率(2.6%vs 5.2%)和术后并发症发生率(10.53%vs 7.89%)比较差异均无统计学意义(P均>0.05)。结论经肛门取标本的腹腔镜乙状结肠癌切除术是安全可行的,并具有微创优势。但对腔镜术者水平要求较高。

Objective To evaluate the safety and effectiveness of laparoscopic sigmoid cancer resection by natural orifice（anal orifice）specimen extraction versus transabdominal specimen extraction. Methods Seventy-six patients with sigmoid cancer admitted between October 2012 and October 2013 were enrolled in this study. The patients were randomly divided into observation group and control group（ n = 38 each）. The laparoscopic sigmoid cancer resection was conducted in all patients. The natural orifice specimen extraction was used in observation group,and the transabdominal specimen extraction was used in control group. The surgery indicator,transfer laparotomy rate and incidence of postoperative complications between two groups were compared. Results The operation time of observation group was significantly longer than that of control group,and the anus exhausting time of observation group was significantly shorter than that of the control group（ all P〈0. 05）. There were no statistical differences in intraoperative bleeding volume and hospitalization stay between two groups（ all P〉0. 05）. The postoperative complications were as follows：1 case of transfer laparotomy due to ureteral tumor invasion was seen in control group;2 cases of transfer transabdominal specimen extraction due to large tumor were seen in observation group;2 cases of wound infection,1 case of urinary tract infection and 1 case of pneumonia were seen in control group;2 cases of abdominal cavity infection and 1 case of intestinal adhesion were seen in observation group. There were no statistical differences in postoperative complication rates between two groups（ P〉0. 05）. Conclusion The laparoscopic sigmoid cancer resection using natural orifice specimen extraction is safe and feasible and has the advantage of minimally invasive,but the demand for technical level of laparoscopy operator is higher.