不同中转开腹时机对腹腔镜结直肠癌患者术后恢复及生存情况的影响

Influence of different timing of conversion to laparotomy on postoperative recovery and survival of laparoscopic colorectal cancer patients

目的探讨不同中转开腹手术时机对腹腔镜结直肠癌患者术后恢复及生存情况的影响。方法选取86例行腹腔镜结直肠癌根治术的结直肠癌患者,依据中转开腹的时机分为早期组(n=45)和延迟组(n=41),早期组患者于腹腔镜手术切皮后1 h内中转开腹手术,延迟组患者于切皮后1 h后中转开腹手术。比较两组患者围手术期相关指标、术后并发症发生情况和随访1年总生存率。结果早期组患者手术时间、首次排气时间、首次排便时间、术后住院时间均明显短于延迟组(P﹤0.01),术中出血量、术后引流量均明显少于延迟组(P﹤0.01)。早期组患者的术后并发症总发生率为8.89%,低于延迟组患者的26.83%(P﹤0.05)。随访1年,早期组患者的总生存率为74.4%,高于延迟组患者的63.8%,但差异无统计学意义(P﹥0.05)。结论腹腔镜手术切皮后1 h内中转开腹手术可明显缩短手术时间,减少术中出血量及术后引流量,降低术后并发症发生率,促进患者术后恢复。

Objective To investigate the effect of different conversion timings to laparotomy on postoperative recovery and survival in patients with laparoscopic colorectal cancer.Method A total of 86 colorectal cancer patients who underwent laparoscopic radical resection of colorectal cancer were selected and divided into the early group(n=45)and the delayed group(n=41)according to the timing of conversion to laparotomy.The patients in the early group were converted to laparotomy within 1 hour after laparoscopic skin incision,and the patients in the delayed group were converted to laparotomy 1 hour after skin incision.The perioperative indicators,postoperative complications and 1-year overall survival rate were compared between the two groups.Result The operation time,first deflation time,first defecation time,and postoperative hospital stay in the early group were significantly shorter than those in the delayed group(P<0.01),and the intraoperative blood loss and postoperative drainage were significantly less than those in the delayed group(P<0.01).The total incidence of postoperative complications in the early group was 8.89%,which was lower than 26.83% in the delayed group(P<0.05).After 1-year follow-up,the overall survival of the early group was 74.4%,which was higher than that 63.8% of the delayed group,however,the difference was not statistically significant(P>0.05).Conclusion Conversion to laparotomy within 1 hour after laparoscopic skin incision could significantly shorten the operation time,reduce the amount of intraoperative blood loss volume and postoperative drainage,reduce the incidence of postoperative complications,and promote postoperative recovery of patients.