腹部无切口腹腔镜低位直肠癌前切除经肛门取出标本的临床分析

Clinical analysis of laparoscopic anterior resection for low rectal cancer patients with no abdominal incision and natural orifice specimen extraction surgery

目的探讨腹部无辅助切口腹腔镜低位直肠癌前切除经肛门自然腔道取出标本的临床应用价值。方法选取2013年1月至2015年6月接受腹腔镜直肠癌手术的94例患者进行回顾性分析,其中27例患者采用经肛门自然腔道取出标本的无腹部切口腹腔镜低位前切除术治疗(无切口组)、67例采用腹腔镜辅助直肠前切除术治疗(常规组),数据分析采用SAS10.0软件处理,围手术期指标、疼痛程度评分采用均数±标准差(x珋±s)表示,组间比较采用t检验;手术并发症发生率采用百分率进行统计描述,比较采用χ2检验;P值<0.05表示差异有统计学意义。结果无切口组患者的手术时间、手术出血量、胃肠道功能恢复时间、住院时间、住院费用均显著的低于常规组患者;术后12、24、48 h,无切口组患者的疼痛程度评分均显著的低于常规组患者,差异均具有统计学意义(P<0.05);清扫淋巴结数目和手术并发症,两组差异不具有统计学意义(P>0.05)。结论经肛门自然腔道标本取出的无切口腹腔镜低位前切除术治疗低位直肠癌效果可靠,手术创伤小、术后患者恢复快。

Objective To explore the clinical value of laparoscopic anterior resection for low rectal cancer patients with no abdominal incision and natural orifice specimen extraction surgery. Methods Retrospective analysis was performed on 94 patients who received laparoscopic rectal cancer surgery from January 2013 to June 2015, 27 cases were treated with laparoscopic anterior resection withno abdominal incision and natural orifice specimen extraction surgery （no incision group） and 67 cases were treated with laparoscopic anterior resection with abdominal assisted incision （conventional group ）. By SAS10.0, perioperative data, pain scores were used mean ＋ standard deviation （x ＋ s） , compared with t test; The rate of complications wered compared with X2 test; P 〈 0.05 meaned the difference was statistically significant. Results The operation time, bleeding volume, recovery time, length of stay, and hospital costs were significantly lower in the no incision group than in the conventional group; After surgery, 12 h, 24 h, 48 h, The pain scores of no incision group were significantly lower than the conventional group, the difference was statistically significant （ P 〈 0.05 ） ; There were no significant difference in the number of lymph nodes and surgical complications between the two groups （ P 〉 0.05 ）. Conclusion laparoscopic anterior resection for low rectal cancer patients with no abdominal incision and natural orifice specimen extraction surgery is reliable, and the operation is more minimally invasive and fast recovery.