减孔较五孔腹腔镜对结直肠癌根治性切除术中出血量、淋巴结清扫数目及恢复情况分析

Clinical analysis of intraoperative blood loss,harvested lymph nodes and postoperative recovery of laparoscopic radical colorectal resection by using 2-holes method

目的探讨减孔腹腔镜手术与五孔腹腔镜手术治疗直肠上段癌和乙状结肠癌的临床效果。方法选取2016年4月至2016年10月本课题组(3家医院)手术治疗的64例直肠上段癌和乙状结肠癌患者,采用随机数字表法进行分组,其中减孔腹腔镜手术治疗32例(减孔组)、传统五孔腹腔镜手术治疗32例(传统组),对比两组患者的围手术期指标、术后恢复情况。数据统计分析采用SPSS16.0进行处理,术中术后指标、VAS评分采用(x珋±s)进行统计描述,采用t检验;中转开腹率、并发症率组间比较采用χ2检验;P值<0.05表示差异具有统计学意义。结果减孔组患者的手术出血量、术后下床活动时间、进食流质饮食时间值均小于传统组(P<0.05);减孔组患者的手术时间长于传统组(P<0.05);两组间术后肛门排气时间、尿管留置时间、住院时间、切除病灶直径、清扫淋巴结数目、下切缘长度比较差异均无统计学意义(P>0.05);术后1、3、5 d,减孔组患者的VAS评分均显著的低于传统组(P<0.05);减孔组的中转开腹率、吻合口漏、肠梗阻、切口感染发生率与传统组差异均无统计学意义(P>0.05)。结论减孔腹腔镜手术较五孔腹腔镜手术治疗直肠上段癌和乙状结肠癌效果相当,更显著的减少出血量、创伤更小、术后疼痛程度更低。

Objective To explore the clinical effect of laparoscopic radical colorectal resection in treating rectal and sigmoid colon cancers by using 2-holes and 5-holes method. Methods From April 2016 to October 2016, 64 patients with upper rectal cancer and sigmoid colon cancer underwent laparoscopic surgery （3 hospitals） were randomly dividing into 2-holes group （32 cases）, and 5-holes group （32 cases）, and perioperative indicators and postoperative recovery were compared by using SPSS 16.0 statistical analysis.Measurement data such as perioperative indicators and VAS scoring were expressed as mean ± standard deviation （ -x ±s）, and were examined by using t test.Count data, such as postoperative complication rate and conversion rate, were expressed as %, and were examined by using χ2 test.A P value〈0.05 was considered as statistically significant difference . Results Compared with 5-holes group, there were significant decrease of intraoperative blood loss , ambulation time and feeding time in 2-holes group （P 〈0.05）.The operation time in 2-holes group was much longer than that in 5-holes group （P 〈0.05）.There were no significant difference between two groups in terms of exhaust time, catheter indwelling time, hospital stay, the diameter of resected lesion, the number of harvested lymph nodes and the length of distal margin （P 〉0.05）.Compared with 5-holes group, significantly lower VAS scoring of patients could be observed 1, 3 and 5 days after operation in 2-holes group （P 〈0.05）.There were no significant difference in terms of rate such as conversion to laparotomy, anastomotic leakage, intestinal obstruction and incision infection between 2 groups （P 〉AS0.05）. Conclusion Compared with 5-holes method, laparoscopic surgery by using 2-holes method has advantages such as less bleeding, less trauma, and lower postoperative pain.