两孔法腹腔镜乙状结肠及直肠上段癌根治性切除术的回顾性对比研究  

A retrospective controlled clinical study of single-incision plus one port laparoscopic surgery for sigmoid colon and upper rectal cancer

作　　者：李国新[1] 李俊蒙 王亚楠[1] 邓海军[1] 牟廷裕[1] 刘浩[1] 

机构地区：[1]南方医科大学南方医院普外科,广州510515

出　　处：《中华外科杂志》2017年第7期515-520,共6页Chinese Journal of Surgery

基　　金：广州市科技计划项目民生科技重大专项（201508020047）;南方医科大学南方医院院长基金（20168021）;南方医科大学科技开发培育计划（KJ20161116）

摘　　要：目的 探讨两孔法腹腔镜（SILS＋1）治疗乙状结肠及直肠上段癌的近期手术效果及肿瘤学疗效.方法 回顾性分析2013年9月至2014年9月在南方医科大学南方医院普通外科接受SILS＋1手术的46例乙状结肠或直肠上段癌患者（两孔组）的临床资料,并采用1∶1的倾向性评分匹配法从同期105例接受传统腹腔镜手术的乙状结肠或直肠上段癌患者中选出46例患者（传统组）.采用t检验、x2检验或秩和检验比较两组之间的基线资料及短期手术疗效,采用Kaplan-Meier法绘制无进展生存曲线,并用Log-rank法比较两组生存曲线的差异.结果 两组患者基线资料具有可比性.两孔组比传统组总切口长度更短[（6.9±1.1）cm比（8.4±1.2）cm,t=6.502,P=0.000],腔内操作时间更短[（67.0±25.8）min比（75.5±27.7）min,t=2.062,P=0.042],术中出血量更少[20（11）ml比50（30）ml,Z=2.414,P=0.016],术后首次下地时间更短[（46.7±20.3）h比（78.6±28.0）h,t=6.255,P=0.000],术后首次经口进食时间更短[（64.7±28.8）h比（77.1±30.0）h,t=2.026,P=0.046],术后住院时间更短[（7.8±2.2）d比（6.5±2.2）d,t=2.680,P=0.009],术后疼痛评分更低（F=4.721,P=0.032）.其余指标未见差异.随访7～39个月,中位随访时间33个月,两孔组复发率为8.7%（4/46）,传统组为6.5%（3/46）,差异无统计学意义（P=0.712）.两孔组3年无进展生存率为91.3%,传统组为93.4%,差异无统计学意义（P=1.000）.结论 对于有丰富腹腔镜经验的术者来说,两孔法腹腔镜治疗乙状结肠及高位直肠癌安全有效,较传统腹腔镜疼痛轻,恢复快.Objective To evaluate the short-term and oncologic outcomes of single-incision plus one port laparoscopic surgery （SILS＋1） for sigmoid colon and upper rectal cancer Methods The clinic data of 46 patients with sigmoid colon and upper rectal cancer underwent SILS＋1 at Department of General Surgery, Nanfang Hospital, Southern Medical University from September 2013 to September 2014 were retrospectively reviewed （SILS＋1 group）. After generating 1∶1 ration propensity scores given the covariates of age, gender, body mass index, American Society of Anesthesiologists score, surgeons, tumor location, the distance of tumor from anal, tumor diameter, and pathologic TNM stage, 46 patients with sigmoid colon and upper rectal cancer underwent conventional laparoscopic surgery （CLS） in the same time were matched as CLS group. The baseline characteristics and short-term outcomes were compared using t test, x2 test or Wilcoxon signed ranks test. Kaplan-Meier survival curves and Log-rank tests demonstrated the distribution of disease free survival.Results The two study groups were well balanced with respect to the baseline characteristics of the propensity score derivation model. As compared to the CLS group, patients in SILS＋1 group had a smaller incision （（6.9±1.1） cm vs. （8.4±1.2） cm, t=6.502, P=0.000）, less estimated blood loss （20（11） ml vs. 50（30） ml, Z=2.414, P=0.016）, shorter intracorporeal operating time （（67.0±25.8） minutes vs. （75.5±27.7） minutes, t=2.062, P=0.042） and significantly faster recovery course including shorter time to first ambulation （（46.7±20.3） hours vs. （78.6±28.0） hours, t=6.255, P=0.000）, shorter time to first oral diet （（64.7±28.8） hours vs. （77.1±30.0） hours, t=2.026, P=0.047）, shorter time of postoperative hospital stay （（7.8±2.2） days vs. （6.5±2.2） days, t=2.680, P=0.009）, and lower postoperative visual analogue scale scores （F=4.721, P=0.032）. No significant difference was observed in total

关 键 词：乙状结肠肿瘤 直肠肿瘤 腹腔镜检查 

分 类 号：R735.3[医药卫生—肿瘤]