手辅助腹腔镜在老年人中上段直肠癌根治术的应用观察
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摘要
目的观察手辅助腹腔镜(HALS)应用于老年人中上段直肠癌根治术的安全性、可行性及有效性。方法诊断为中上段直肠肿瘤、有手术指征并接受直肠癌根治术治疗的47例患者,分为HALS组(22例)和腹腔镜(LAS)(25例)。HALS组采用手辅助腹腔镜手术,LAS组采用腹腔镜辅助手术,比较两组患者术中各项指标、术后恢复情况、术后并发症及肿瘤指标。结果 HALS组手术时间、术中出血量、气腹时间和麻醉时间均少于LAS组(P<0.01);HALS组术后切口更长(P<0.05),住院时间更短(P<0.01);两组的术后并发症及肿瘤指标差异无统计学意义(P>0.05)。结论中上段直肠癌患者应用HALS可缩短手术及麻醉时间,手术安全性高,尤其适合基层医院及腹腔镜初学者。
Objective To observate the safety, feasibility and effectiveness of hand-assisted laparoscopic surgery(HALS)for radical resection of middle and upper rectal cancer in the elderly. Methods Forty-seven patients with mid-upper rectal tumors who had surgical indications and had received radical resection for rectal cancer were divided into the HALS Group(22 cases) and laparoscopic assisted surgery(LAS) Group(25 cases). Hand-assisted laparoscopic surgery was used in the HALS Group while the laparoscopic-assisted surgery was used in the LAS Group. The intraoperative indicators, postoperative recovery, post-operative complications and tumor indicators of patients were compared between the two groups. Results The operation time, intraoperative bleeding volume, pneumoperitoneum time and anesthesia time of the HALS Group were all less than those of the LAS Group(P<0.01); and the HALS Group had a longer incision length(P<0.05) and shorter hospital stay(P<0.01). There was no significant difference in postoperative complications and tumor indicators between the two groups(P>0.05). Conclusion HALS can shorten the operation duration and anesthesia time for patients with upper and middle rectal cancer. It is a safe operation, and especially suitable for primary hospitals and the beginners of laparoscopy.
Objective To observate the safety, feasibility and effectiveness of hand-assisted laparoscopic surgery(HALS)for radical resection of middle and upper rectal cancer in the elderly. Methods Forty-seven patients with mid-upper rectal tumors who had surgical indications and had received radical resection for rectal cancer were divided into the HALS Group(22 cases) and laparoscopic assisted surgery(LAS) Group(25 cases). Hand-assisted laparoscopic surgery was used in the HALS Group while the laparoscopic-assisted surgery was used in the LAS Group. The intraoperative indicators, postoperative recovery, post-operative complications and tumor indicators of patients were compared between the two groups. Results The operation time, intraoperative bleeding volume, pneumoperitoneum time and anesthesia time of the HALS Group were all less than those of the LAS Group(P<0.01); and the HALS Group had a longer incision length(P<0.05) and shorter hospital stay(P<0.01). There was no significant difference in postoperative complications and tumor indicators between the two groups(P>0.05). Conclusion HALS can shorten the operation duration and anesthesia time for patients with upper and middle rectal cancer. It is a safe operation, and especially suitable for primary hospitals and the beginners of laparoscopy.
引文
[1]孙石平.手辅助腹腔镜与腹腔镜辅助手术治疗结直肠癌的对比研究[J].中国医疗器械信息, 2018, 24(18):46-47.
[2] TEKKIS P P, SENAGORE A J, DELANEY C P, et al.Evaluation of the learning curve in laparoscopic colorectal surgery:comparison of right-sided and left-sided resections[J]. Ann Surg, 2005, 242(1):83-91.
[3]刘逸,揭志刚,李正荣,等.手辅助腹腔镜在结直肠肿瘤中的临床应用[J].实用肿瘤杂志, 2013, 28(4):411-413.
[4] BOLAND J P, KUSMINSKY R E, THEY E H. Laparoscopic minilaparotomy with manipulation:the middle path[J].Minim Invasive Ther, 1993, 2(2):63-67.
[5]韩卓兴,陈春雷,林晖,等.手辅助腹腔镜左肝外叶切除术治疗肝内胆管结石的临床应用[J].广东医科大学学报,2019, 37(2):201-203.
[6] LEBLANC F, DELANEY C P, ELLIS C N, et al. Handassisted versus straight laparoscopic sigmoid colectomy on a training simulator:what is the difference? A stepwise comparison of hand-assisted versus straight laparoscopic sigmoid colectomy performance on an augmented reality simulator[J]. World J Surg, 2010, 34(12):2909-2914.
[7] IKEDA Y, SASAKI Y, NIIMI M, et al.Hand-assisted laparoscopic proximal gastrectomy with jejunal interposition and lymphadenectomy[J]. J Am Coll Surg, 2002, 195(4):578-581.
[8]王国森,周建平,盛伟伟,等.手辅助腹腔镜、腹腔镜辅助和开腹结直肠癌手术近期疗效的比较[J].中国医科大学学报, 2017, 46(2):126-130, 135.
[9]韩方海,赵志,吴建海,等.手辅助腹腔镜直肠癌低位(超低位)前切除术与开腹手术近期疗效对比的研究[J].临床普外科电子杂志, 2013, 1(3):18-22, 43.
[10] PAI V D, BHANDARE M, SAKLANI A P. Laparoscopic total mesorectal excision with enbloc resection of seminal vesicle for locally advanced rectal adenocarcinoma[J]. J Laparoendosc Adv Surg Tech A, 2016, 26(3):209-212.
[11] MYERS E A, FEINGOLD D L, ARNELL T D, et al. The rate for the use of hand-assisted laparoscopic methods is directly proportional to body mass index[J]. Surg Endosc,2014, 28(1):108-115.
[2] TEKKIS P P, SENAGORE A J, DELANEY C P, et al.Evaluation of the learning curve in laparoscopic colorectal surgery:comparison of right-sided and left-sided resections[J]. Ann Surg, 2005, 242(1):83-91.
[3]刘逸,揭志刚,李正荣,等.手辅助腹腔镜在结直肠肿瘤中的临床应用[J].实用肿瘤杂志, 2013, 28(4):411-413.
[4] BOLAND J P, KUSMINSKY R E, THEY E H. Laparoscopic minilaparotomy with manipulation:the middle path[J].Minim Invasive Ther, 1993, 2(2):63-67.
[5]韩卓兴,陈春雷,林晖,等.手辅助腹腔镜左肝外叶切除术治疗肝内胆管结石的临床应用[J].广东医科大学学报,2019, 37(2):201-203.
[6] LEBLANC F, DELANEY C P, ELLIS C N, et al. Handassisted versus straight laparoscopic sigmoid colectomy on a training simulator:what is the difference? A stepwise comparison of hand-assisted versus straight laparoscopic sigmoid colectomy performance on an augmented reality simulator[J]. World J Surg, 2010, 34(12):2909-2914.
[7] IKEDA Y, SASAKI Y, NIIMI M, et al.Hand-assisted laparoscopic proximal gastrectomy with jejunal interposition and lymphadenectomy[J]. J Am Coll Surg, 2002, 195(4):578-581.
[8]王国森,周建平,盛伟伟,等.手辅助腹腔镜、腹腔镜辅助和开腹结直肠癌手术近期疗效的比较[J].中国医科大学学报, 2017, 46(2):126-130, 135.
[9]韩方海,赵志,吴建海,等.手辅助腹腔镜直肠癌低位(超低位)前切除术与开腹手术近期疗效对比的研究[J].临床普外科电子杂志, 2013, 1(3):18-22, 43.
[10] PAI V D, BHANDARE M, SAKLANI A P. Laparoscopic total mesorectal excision with enbloc resection of seminal vesicle for locally advanced rectal adenocarcinoma[J]. J Laparoendosc Adv Surg Tech A, 2016, 26(3):209-212.
[11] MYERS E A, FEINGOLD D L, ARNELL T D, et al. The rate for the use of hand-assisted laparoscopic methods is directly proportional to body mass index[J]. Surg Endosc,2014, 28(1):108-115.