超声刀与电刀在Miles手术中的临床对照研究

Clinical control study on ultrasound knife and electrotome applied to Miles operation

目的比较超声刀与电刀在直肠癌腹会阴联合切除术（Miles）中的临床应用疗效。方法 2008年10月~2013年12月本中心遵循直肠全系膜切除（TME）的原则,对184例直肠癌患者实施Miles手术,其中98例采用超声刀（超声刀组）,86例采用传统术式（电刀组）,对比两组的手术相关指标、术后恢复指标以及术后并发症等。结果超声刀组的手术时间、术中出血量、术后24 h引流量明显低于电刀组,术中输血例数、术后并发症少于电刀组,而淋巴结清扫数目多于电刀组（均P〈0.05）。结论采用超声刀行Miles手术,具有精确切割、凝血可控性好、出血少、手术时间短、术后并发症少等优点,且肿瘤根治效果显著,有很好的临床应用价值。

Objective To make comparison between the clinical application effects of ultrasound knife and electrotome in Miles operation. Methods 184 rectal cancer patients received the Miles operation between October 2008 and December 2013 according to the principle of total mesoreectal excision（TME）,in which there were 98 patients treated by ultrasound knife and 86 patients treated by traditional operation（electrotome）. Comparison was made in the operation correlated indexes, postoperative recovery indexes, and the complications after the operation between the two groups. Results The average operation time, intraoperative blood loss, and drainage volume within 24 hours after the operation in the ultrasound knife group were significantly less than those in the electrotome group.The cases of intraoperative blood transfusion and the postoperative complications in the former group were less than those in the latter group, but its number of lymphade node dissection was more than that in the latter one（all P 0.05）. Conclusion The use of ultrasound knife in the Miles operation has advantages of precise cutting, good controllability of coagulation, less volume of blood loss,shorter operation time, fewer postoperative complications, and more obvious effect on the radical cure of tumor. It has a great clinical application value.