腹腔镜直肠癌前切除术难易程度的相关因素分析  

Evaluation of factors affecting the technical difficulty of laparoscopic anterior resection for rectal cancer

作　　者：廖健南[1,2] 郭水莲[1,2] 刘展慧[1,2] 邱磊[1,2] 谢沛标[1,2] 钟育波[1,2] 魏君[1,2] 

机构地区：[1]南方医科大学附属佛山医院 [2]佛山市第二人民医院,广东佛山528000

出　　处：《腹腔镜外科杂志》2014年第7期505-508,共4页Journal of Laparoscopic Surgery

基　　金：广东省佛山市医学类科技攻关项目课题(编号:201308085)

摘　　要：目的：探讨腹腔镜直肠癌前切除术难易程度的影响因素。方法：对2012年1月至2014年3月112例行腹腔镜直肠癌前切除术患者的临床资料进行单因素分析,筛选出可能影响手术难度的因素,再对影响因素进行Logistic回归分析,从而确定手术难度的相关因素。结果：手术时间130-210 min,中位时间180 min;术中出血量60-150 ml,中位出血量85 ml。8例（7.1%）中转开腹,应用Logistic回归分析确定腹腔镜直肠癌前切除术难度的独立影响因素为男性（P=0.001,OR=13.616）、BMI≥28 kg/m^2（P=0.02,OR=16.566）、肿瘤长径≥4 cm（P=0.000,OR=25.440）、肿瘤距肛缘距离〈6 cm（P=0.000,OR=70.133）、骨盆坐骨棘间径〈9.5 cm（P=0.001,OR=21.503）、骨盆骶尾间距≥12.2 cm（P=0.045,OR=4.320）。结论：男性、肥胖、肿瘤体积大、位置低及深窄骨盆的直肠癌患者,行腹腔镜直肠癌前切除术的难度较大。术前明确影响手术难度的相关因素可评估手术风险,为手术方式的选择提供依据。Objective：To explore factors affecting the technical difficulty of laparoscopic anterior resection for rectal cancer.Methods：Univariate analysis was performed for the preoperative clinical data of the 112 patients who underwent laparoscopic anterior resection for rectal cancer in department of general surgery area 3 Foshan Second People＇s Hospital from Jan. 2012 to Mar. 2014. The possible factors affecting the technical difficulty were screened out,and further identified by multivariate logistic regression analysis. Results：The median value of operative time and intraoperative blood loss in 112 patients were 180（130-210） min and 85（60-150） ml respectively. 8 patients were converted to open surgery,and the conversion rate was 7. 1%. According to the logistic regression analysis,the factors affecting the technical difficulty of laparoscopic anterior resection for rectal cancer included male（ P = 0. 001,OR =13. 616）,BMI≥28 kg /m^2（P =0. 02,OR =16. 566）,diameter of tumor≥4 cm（P =0. 000,OR =25. 440）,distance between the tumor and the anal edge 〈6 cm（P = 0. 000,OR = 70. 133）,the interspinous distance〈 9. 5 cm（ P = 0. 001,OR = 21. 503）,the distance from sacral promontory to the tip of coccyx≥12. 2 cm（P = 0. 045,OR = 4. 320）. Conclusions：Laparoscopic anterior resection is performed more difficultly in male obese patients with large and low tumor and the deep and narrow pelvis. Identification of preoperative factors affecting the technical difficulty could evaluate the operation risk and provide the basis for the choice of operation method.

关 键 词：直肠肿瘤 腹腔镜检查 难易程度 影响因素 

分 类 号：R735.37[医药卫生—肿瘤]