可旋转3D腹腔镜在直肠癌前切除术中的临床体会和特点  

The clinical application of 3D rotatable laparoscopic anterior resection for rectal cancer

作　　者：耿岩[1] 剧永乐[1] 陆光生[1] 任宝军[1] 张炎祥[1] 封静[1] 

机构地区：[1]南方医科大学顺德医院普通外科,广东顺德528300

出　　处：《岭南现代临床外科》2017年第2期162-165,共4页Lingnan Modern Clinics in Surgery

基　　金：国家卫计委医药卫生科技发展研究中心课题(W2014RQ36);佛山市十三五(高水平)重点专科建设项目(FSGSPZD135051)

摘　　要：目的总结可旋转3D腹腔镜直肠癌前切除手术中的经验,初步探索与2D腹腔镜对比的优势。方法回顾性分析2014年10月至2016年9月,我院86例行腹腔镜下直肠癌前切除术患者的临床资料,其中3D腹腔镜组40例,2D腹腔镜组46例,对比两种方式在手术时间、术中出血量、术后排气时间、术后平均住院时间、淋巴结清扫数量等指标的差异。结果 86例直肠癌前切除术均在腹腔镜下完成。与2D腹腔镜组相比,3D腹腔镜组具有一定优势,如定位准确层次清晰,术中出血更少(35.0±16.8 mL vs.44.3±18.2 mL,t=-2.449,P=0.016)。两组手术时间(126.2±24.2 min vs.131.8±30.2 min,t=-0.939,P=0.350),术后排气时间(2.7±1.2d vs.2.8±0.9 d,t=-0.441,P=0.661),术后住院时间(8.4±2.6 d vs.8.6±2.5 d,t=-0.363,P=0.717),淋巴结清扫数量两组间(16.4±3.4个vs.15.8±5.2个,t=0.623,P=0.535)均无显著差异。结论可旋转3D腹腔镜应用于腹腔镜直肠癌前切除手术是安全可行的,可旋转3D腹腔镜与2D腹腔镜有着一样的操作灵活性,但其空间定位更加准确,解剖层次更加清晰,分离更为精细。Objective To summarize the experience and feasibility of three-dimensional （3D） rotatable laparoscopic anterior resection for rectal cancer and compare with two-dimensional （ 2D ） lapa- roseopy. Methods We retrospectively analyzed 86 cases （from Oct. 2014 to Sep. 2016） of rectal cancer for laparoscopy （40 cases for 3D group and 46 cases for 2D group）. We compared the mean of operation duration, intraoperative blood loss, postoperative exhaust time, postoperative hospital stay, number of lymph node dissection between two groups. Results All cases were performed with laparoscopic procedure. As compared to 2D group, 3D group had less blood loss （35.0±16.8 ml vs. 44.3±18.2 ml, t=- 2.449, P=0.016 ）. No significant differences were seen in operative time （ 126.2±24.2 min vs. 131.8± 30.2min, t=-0.939, P=0.350）, postoperative exhaust time （2.7±1.2 d vs. 2.8±0.9 d, t=-0.441, P=0.661 ）, postoperative hospital stay （8.4±2.6 d vs. 8.6±2.5 d, t=-0.363, P=0.717 ） , number of lymph node dissection （16.4±3.4 vs. 15.8±5.2, t=0.623,P=0.535） between two groups. Conclusions It is safe to 3D rotatable laparoscopic anterior resection for rectal cancer. Compared with 2D laparoseopy, 3D rotat- able laparoscopy is same in flexibility of operation, but it can give us more accurate space orientation, more distinct anatomical layer and more exquisite separation.

关 键 词：3D腹腔镜 直肠癌 直肠癌前切除术 

分 类 号：R657.1[医药卫生—外科学] R735.37[医药卫生—临床医学]