加速康复外科联合单孔腹腔镜技术应用于直肠癌手术的临床研究  

Single-incision laparoscopic surgery combined with fast-track rehabilitation for rectal cancer

作　　者：谢立飞[1,2] 江志伟[1] 鲍扬[1] 王刚[1] 黎介寿[1] 

机构地区：[1]南京大学医学院临床学院(南京军区南京总医院)解放军普通外科研究所,南京医学硕士210002 [2]无锡市第四人民医院

出　　处：《医学研究生学报》2012年第12期1261-1264,共4页Journal of Medical Postgraduates

基　　金：江苏省社会发展基金(BS2007054);南京军区科技创新基金(07Z028)

摘　　要：目的加速康复外科(fast track surgery,FTS)理念以及单孔腹腔镜手术(single-incision laparoscopic surgery,SILS)可进一步减少创伤、加快患者术后康复。文中拟探讨FTS联合SILS应用于直肠癌患者围手术期的安全性。方法择期行直肠癌手术患者40例分为2组,应用FTS理念联合传统腹腔镜手术22例作为FTS腔镜组,应用FTS理念联合SILS 18例作为FTS单孔组。比较2组病例平均手术时间、术中出血量、淋巴结清扫数目、手术切口长度、术后肛门通气时间、术后住院天数、术后并发症以及住院费用等指标。结果 2组病例的术后肛门通气时间及术后住院天数,差异无统计学意义(P>0.05),与相关文献报道的采用传统围手术期处理措施的腹腔镜手术相比较,术后住院时间缩短。FTS单孔组较FTS腔镜组手术切口长度明显缩短,手术时间延长,差异有统计学意义(P<0.01);2组术中出血量、淋巴结清扫数目、术后并发症以及住院费用差异无统计学意义(P>0.05)。结论 FTS理念指导下的传统腹腔镜手术以及SILS均能加快肠功能恢复、缩短住院时间;相对于传统腹腔镜手术,SILS因其手术切口缩小而减轻了术后疼痛,加速了康复,因手术瘢痕减少和缩短,故不影响局部外观。Objective Single-incisionlaparoscopic surgery （SILS） with fast-track rehabilitation （FTR） can further reduce trauma and accelerate postoperative rehabilitation. This study aims to investigate the safety of SILS with FTR in the treatment of rectal cancer. Methods Forty patients with rectal cancer were randomly assigned to receive traditional laparoscopic surgery plus FTR （n =22） and SILS plus FTR （n = 18）, respectively. Comparisons were made between the two groups in the mean operation time, in- tra-operative blood loss, the number of lymphnodes excised, the length of incision, the time to first flatus, postoperative hospital stay, postoperative complications and medical cost. Results There were no significant differences in the first flatus time and postoperative hospital stay between the two groups （ P 〈 0.05 ）, but the postoperative hospital stay was decreased as compared with traditional laparo- scopic surgery reported in other literature. The length of incision was shorter and the mean operation time longer in the patients treated by SILS than that in FTS with traditional laparoseopic surgery （both P 〈 0.01 ）. No statistically significant differences were found be- tween the two groups in intra-operative blood loss, the number of lymphnodes excised, postoperative complications and medical treat- ment cost （P 〈 O. 05）. Conclusion SILS plus FTR can shorten postoperative hospital stay and facilitate bowel function recovery in the treatment of rectal cancer. What＇s more, it achieves a smaller incision than traditional laparoscopic surgery plus FTR.

关 键 词：加速康复外科 单孔腹腔镜手术 腹腔镜手术 直肠癌 

分 类 号：R735.37[医药卫生—肿瘤]