腹腔镜直肠癌前切除术中转开腹影响因素的多因素分析

A Multivariate Analysis of Conversion to Laparotomy in Laparoscopic Anterior Resection of Rectal Cancer

目的探讨腹腔镜直肠癌前切除术中转开腹的影响因素。方法回顾性分析2006年4月-2012年10月我科472例腹腔镜直肠癌前切除术的临床资料,采用单因素分析及logistic回归分析中转开腹的原因。结果中转开腹47例,占10.0%（47/472）。单因素分析显示,BMI、肿瘤直径、肿瘤浸润深度、大体分型、术中出血、术野暴露情况及手术团队成员稳定性有显著性差异（P〈0.05）。logistic回归分析显示,肿瘤浸润（OR=2.453,95%CI：1.251-4.773,P=0.009）、术中出血（OR=1.116,95%CI：1.052-1.232,P=0.002）及术野暴露情况（OR=0.491,95%CI：0.250-0.964,P=0.039）是中转开腹的独立影响因素。结论肿瘤浸润较重、局部病期较晚的患者不推荐腹腔镜手术。术中出血过多难以控制须立即中转开腹。腹腔镜手术组应固定人员组成,尤其是持镜医师不能随意更换,良好的暴露是成功完成腹腔镜直肠癌前切除术的关键。

Objective To investigate influential factors of conversion to laparotomy in laparoscopic anterior resection of rectal cancer. Methods Clinicopathologic data of 472 patients who underwent laparoscopic rectal cancer resection between April 2006 and October 2012 in this department were analyzed retrospectively. The causes of conversion to laparotomy were investigated with univariate analysis and logistic regression. Results Among the 472 patients,47 cases were converted to open surgery（ 10. 0%）. Univariate analysis showed that body mass index（ BMI）,tumor size,tumor infiltration,gross type,blood loss,exposure of the operative field and the stability of surgical team staff were related to conversion（ P〈0. 05）. Multivariate analysis demonstrated that tumor invasion（ OR =2. 453,95% CI： 1. 251- 4. 773,P = 0. 009）,blood loss（ OR = 1. 116,95% CI： 1. 052- 1. 232,P = 0. 002） and exposure of the operative field（ OR = 0. 491,95% CI： 0. 250- 0. 964,P = 0. 039） were independent factors of conversion to laparotomy.Conclusions Tumor invasion and local advanced lesion are not recommended for laparoscopic surgery. Excessive bleeding is difficult to control and require immediate laparotomy. The staff of laparoscopy group should keep stable, especially avoiding frequent replacement of laparoscopy-holder. Good exp osure of surgical field is a key of success for laparoscopic anterior resection of rectal cancer.