开腹手术史对腹腔镜结肠癌根治术效果的影响

Influence of laparotomy history on laparoscopic radical resection of colon cancer

目的探讨开腹手术史对腹腔镜结肠癌根治术效果的影响。方法选择2013年1月至2016年1月驻马店市中心医院收治的36例有开腹手术史的结肠癌患者为观察组,并选择同期收治的80例无开腹手术史的结肠癌患者为对照组,2组患者均行腹腔镜结肠癌根治术。记录2组患者的手术时间、术中出血量、中转开腹率、清扫淋巴结数目、术后首次排气时间、术后首次进食时间、术后住院时间及并发症;所有患者术后随访2 a,记录无病生存率。结果观察组患者手术时间长于对照组,术中出血量多于对照组(P <0. 05); 2组患者清扫淋巴结数目、术后首次排气时间、首次进食时间及住院时间比较差异均无统计学意义(P> 0. 05)。观察组和对照组患者中转开腹率分别为19. 44%(7/36)、8. 75%(7/80),观察组患者中转开腹率高于对照组(χ~2=7. 627,P <0. 05)。观察组和对照组患者并发症发生率分别为22. 22%(8/36)、10. 00%(8/80),观察组患者并发症发生率高于对照组(χ~2=4. 856,P <0. 05)。观察组和对照组患者术后2 a无病生存率分别为47. 22%(17/36)、51. 25%(41/80),2组患者术后2 a无病生存率比较差异无统计学意义(χ~2=1. 856,P> 0. 05)。结论开腹手术史会延长腹腔镜结肠癌根治术的手术时间,增加中转开腹手术和术后并发症的风险。

Objective To investigate the influence of laparotomy history on laparoscopic radical resection of colon cancer.Methods A total of 36 colon cancer patients with laparotomy history in Zhumadian Central Hospital from January 2013 to January 2016 were selected as observation group,and 80 colon cancer patients without laparotomy history were selected as control group.All patients were performed with laparoscopic radical resection of colon cancer.The operation time,intraoperative bleeding volume,the rate of converting to laparotomy,the number of lymph nodes cleared,postoperative first exhaust time,postoperative first eating time and postoperative hospitalization time and complications were recorded.All patients were followed up for two years to record the disease-free survival rate.Results The operation time in the observation group was longer than that in the control group,and the intraoperative bleeding volume in the observation group was more than that in the control group(P<0.05).There was no significant difference in the number of lymph nodes cleared,postoperative first exhaust time,postoperative first eating time and postoperative hospitalization time between the two groups(P>0.05).The rate of converting to laparotomy in the observation group and the control group was 19.44%(7/36)and 8.75%(7/80),respectively.The rate of converting to laparotomy in the observation group was higher than that in the control group(χ^2=7.627,P<0.05).The incidence of complications in the observation group and the control group was 22.22%(8/36)and 10.00%(8/80),respectively.The incidence of complications in the observation group was higher than that in the control group(χ^2=4.856,P<0.05).The 2-year disease-free survival rate in the observation group and the control group was 47.22%(17/36)and 51.25%(41/80),respectively.There was no significant difference in the 2-year disease-free survival rate between the two groups(χ^2=1.856,P>0.05).Conclusion The laparotomy history can prolong the operation time of laparoscopic radical resection of colon cancer and increase the risk of converting to laparotomy and complications.