| 陈 奎,刘牧林,陈家来,王 珊,王栓虎.腹腔镜下完整系膜切除术治疗结肠癌的临床效果[J].,2018,(16):3157-3161 |
| 腹腔镜下完整系膜切除术治疗结肠癌的临床效果 |
| Clinical Application of Laparoscopic Complete Mesocolic Resection for Colorectal Cancer |
| 投稿时间：2018-01-31 修订日期：2018-03-02 |
| DOI：10.13241/j.cnki.pmb.2018.16.035 |
| 中文关键词: 腹腔镜 完整系膜切除术 结肠癌 |
| 英文关键词: Laparoscopic Complete mesocolic resection Colorectal cancer |
| 基金项目:蚌埠医学院2016年度自然科学基金面上项目(byky1680) |
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| 中文摘要: |
| 摘要 目的：探讨腹腔镜下完整系膜切除术治疗结肠癌中的临床效果及安全性。方法：选取2015年1月至2017年5月在本院经纤维结肠镜及活组织病理检查确诊为结肠癌的患者作为研究对象，并按照手术方式不同分为开腹手术组及腹腔镜手术组两组，每组各选取93例。开腹手术组采用开腹完整结肠系膜结肠癌根治术进行治疗，腹腔镜手术组采用腹腔镜下完整结肠系膜切除结肠癌根治术进行治疗，比较两组的手术指标、术后并发症和手术质量。结果：与开腹手术组比较，腹腔镜手术组手术时间延长，术中出血量减少，术后排气时间缩短，术后引流量减少，引流管拔管时间缩短，住院时间缩短(P＜0.05)。腹腔镜手术组术后并发症总发生率(20.43%)显著低于开腹手术组(35.48%)(P＜0.05)；切口相关感染发生率(1.08%)明显低于开腹手术组(6.45%)，但差异无统计学意义(P＞0.05)；总感染发生率(11.83%)低于开腹手术组(30.11%)(P＜0.05)。腹腔镜手术组与开腹手术组均达到完整系膜切除标准，肿瘤组织、系膜等均整块完整切除且系膜未发现损伤，切除标本质量分级达到C级及以上，切除肠管均距离恶性肿瘤上缘10 cm、下缘15 cm，且对切除肠管上切缘及下切缘的病理组织学检查结果均未发现恶性肿瘤细胞。腹腔镜手术组与开腹手术组在清扫淋巴结数量、肿瘤TNM病理分期方面比较均未发现具有统计学差异(P＞0.05)。腹腔镜手术组肿瘤大小明显小于开腹手术组(P＜0.05)。结论：腹腔镜下完整系膜切除术治疗结肠癌的手术创伤小，可降低术后并发症发生率，但手术时间还有待优化，应用指征还有待进一步拓宽。 |
| 英文摘要: |
| ABSTRACT Objective: To explore the application of laparoscopic complete mesocolic resection for colorectal cancer. Methods: Patients with colorectal cancer confirmed by colonoscopy and biopsy diagnosis from January 2015 to May 2017 in our hospital were selected as the research object, and randomly divided into the laparotomy group and the laparoscopic surgery group according to the different methods of operation, 93 cases in each group. The open surgery group was given open radical resection of colorectal with complete membrane colorectal cancer, laparoscopic surgery group was given complete mesocolic laparoscopic resection of colorectal cancer radical treatment, the operation indexes, postoperative complications and surgical quality. of the two groups were compared. Results: Compared with the open surgery group, the operation time prolonged, intraoperative bleeding decreased, postoperative exhaust time, drainage time and hospitalization time were shortened, postoperative drainage volume reduced in the laparoscopic surgery group(P<0.05). The postoperative complication rate (20.43%) was lower in the laparoscopic surgery group than the laparotomy group (35.48%)(P<0.05); the incision related infection rate was 1.08% (1/93) was lower(6.45%) with no statistically significant difference (P>0.05); the sense hair coloring birth rate (11.83%) was lower than that of the laparotomy group (30.11%)(P<0.05). Laparoscopic group and open surgery group achieved complete resection, tumor tissue, mesangial are whole complete resection and mesangial resection specimens showed no damage, quality grade reaches C grade and above, cut in addition to intestinal malignant tumors were from 10 cm to the edge of the lower edge, 15 cm and the margin and margin of resection on histopathological examination results were not found in malignant tumor cells. Laparoscopic group and open surgery group in the number of dissected lymph nodes, tumor staging and pathological aspects of TNM showed no statistically significant difference(P>0.05), the tumor size of laparoscopic surgery group was lower than that of the open surgery group(P<0.05). Conclusion: Laparoscopic complete mesocolic resection can significantly reduce the amount of bleeding, postoperative exhaust time, postoperative drainage, drainage time and hospitalization time, reduce the incidence of postoperative complications in the treatment of colorectal cancer, but the operation time remains to be optimized, application indication should be further widened. |
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