腹部无切口经直肠取出标本的腹腔镜乙状结肠癌根治术与传统腹腔镜手术近期效果比较  

Comparison of short-term outcomes of transrectal specimen extraction during laparoscopic sigmoid radical resection versus conventional laparoscopically assisted procedure

作　　者：邢俊杰[1] 张辰新[1] 杨晓虹[1] 王颢[1] 王汉涛[1] 于恩达[1] 傅传刚[2] 

机构地区：[1]第二军医大学长海医院肛肠外科,上海200433 [2]同济大学附属东方医院胃肠肛肠外科,上海200120

出　　处：《中华胃肠外科杂志》2017年第6期665-670,共6页Chinese Journal of Gastrointestinal Surgery

摘　　要：目的 比较腹部无切口经直肠取出标本腹腔镜乙状结肠癌根治术与传统腹腔镜手术的近期手术效果。方法 上海第二军医大学长海医院肛肠外科于2015年12月至2016年4月期间，从拟行腹腔镜辅助乙状结肠癌根治术的患者中选择术前影像学评估为T1~3期且无远处转移以及体质指数（BMI）〈 28 kg/m2的16例，行腹部无切口经直肠取出标本乙状结肠癌根治术（无切口组，手术取标本步骤：会阴部扩肛，腹腔内在直肠结扎线远端切开直肠，经右下腹Trocar孔置入腔镜套，经直肠断端由肛门牵出体外形成取物通道。将拟切除肠段置入取物通道，游离标本经肛门完整取出），其中女性4例，男性12例。采用1∶2的病例配对方式（性别一致、年龄和BMI相近且手术时间相差不超过6个月），从行传统腹腔镜乙状结肠癌根治术的患者中选择32例（传统对照组），女性8例，男性24例。分析比较两组的围手术期情况和手术标本病理情况。结果 两组患者性别、年龄、BMI、肠镜下肿瘤距肛缘距离以及肿瘤T分期等基线资料的比较，差异均无统计学意义（均P 〉 0.05）。相比传统对照组，虽然无切口组患者的手术时间稍长[（140.6 ± 8.3）min比（122.2 ± 26.2）min，t=-3.629，P= 0.001]，术中出血量增多[（43.8 ± 9.2）ml比（35.3 ± 10.2）ml，t=-2.795，P= 0.008]，但术后排气时间早[（43.1 ± 8.3）h比（52.0 ± 11.4）h，t= 2.756，P= 0.008]，手术当天和术后第1天的疼痛评分较低[（3.8 ± 0.8）分比（4.8 ± 1.1）分，t= 3.558，P= 0.001；（2.6 ± 0.6）分比（3.8 ± 0.8）分，t= 5.165，P= 0.000]。两组术后附加镇痛（额外使用镇痛药物）的比例[6.3%（1/16）比18.8%（6/32）]、术后住院时间[（6.8 ± 3.4）d比（5.6 ± 0.8）d]以及术后并发症发生率[12.5%（2/16）比9.4%（3/32）]比较，差异均无统计学意义（均P 〉 0.05）。术后30 d内，无切口组�Objective To compare the short-term outcomes between transrectal specimen extraction during laparoscopic sigmoid radical resection and conventional laparoscopy-assisted sigmoid radical resection.Methods Sixteen patients （transrectal specimen extraction group, 4 females and 12 males） , who were planned to undergo laparoscopically assisted sigmoid radical resection with BMI 〈 28 kg/m2 and were evaluated as T1-T3 tumor by iconography without distant metastasis, were selected to undergo transrectal specimen extraction during laparoscopic sigmoid radical resection from December 2015 to April 2016 in the Department of Anorectal Surgery of Changhai Hospital. The procedure of specimen extraction was as follows： Perineal anal expansion was performed. The rectum was cut in rectal distal ligature within the abdominal cavity. Telescope cover was placed through Trocar hole in right low abdomen and rectal stump was pulled out of the body through the anus to form an access tunnel. Planned resected bowel was placed in the tunnel and the specimen was dissociated and removed completely from anus. Each patient in transrectal specimen extraction group was individually matched with two patients who underwent laparoscopically assisted sigmoid radical resection by gender, age, BMI and date of surgery. The perioperative outcomes and pathological evaluation of surgical specimen of two groups were retrospectively collected and compared.Results The differences of baseline data （gender, age, BMI, distance from tumor to anal verge measured by colonoscopy and clinical tumor category） between two groups were not significant （all P 〉 0.05） . Compared to laparoscopy-assisted group, transrectal specimen extraction group presented longer operation time[ （140.6 ± 8.3） minutes vs. （122.2 ± 26.2） minutes, t=-3.629, P= 0.001], and more blood loss[ （43.8 ± 9.2） ml vs. （35.3 ± 10.2） ml, t=-2.795, P= 0.008], but shorter time to first flatus[ （43.1 ± 8.3） hours vs. （52.0 ± 11.4） hours, t= 2.756, P= 0.008]and

关 键 词：腹部无切口 腹腔镜 乙状结肠癌根治术 近期疗效 

分 类 号：R735.35[医药卫生—肿瘤]