悬吊式无气腹腹腔镜手术治疗老年结直肠癌的对比研究  

A comparative study on non-pneumoperitoneum and pneumoperitoneum laparoscopic surgeries in the treatment of colorectal cancer in the elderly

作　　者：雷跃华[1] 杨玉辉[1] 陈文兴[1] 王邓超 李曦[1] 

机构地区：[1]四川省自贡市第四人民医院普通外科,四川自贡643000

出　　处：《实用医院临床杂志》2017年第6期120-122,共3页Practical Journal of Clinical Medicine

摘　　要：目的比较无气腹悬吊式与气腹腹腔镜手术治疗老年结直肠癌的可行性和临床疗效。方法选择我院普外科2011年6月至2016年6月收治的年龄≥65岁、合并心肺基础疾病的结直肠癌患者86例,分为无气腹悬吊手术组和传统气腹腹腔镜组各43例,比较两组患者的手术时间、术中出血量、术后肛门排气时间、术后平均住院日以及术中2小时节点中心静脉压(CVP)、动脉血气分析PaCO_2数值。结果无气腹组有3例中转开腹、气腹组2例中转开腹,均排除此次研究,余病例手术顺利完成。两组均无死亡病例,手术时间、术中出血量情况比较差异无统计学意义(P>0.05);但术后肛门排气时间、术后平均住院日以及术中2小时节点CVP、PaCO_2数值方面差异有统计学意义(P<0.05)。结论无气腹腹壁悬吊式腹腔镜手术扩大了腹腔镜手术适应症,其避免了CO_2气腹对心肺功能的影响,对于老年、特别是合并有心肺基础疾病患者,无气腹腹壁悬吊腹腔镜手术是一种较理想的微创手术方式。Objective To compare the feasibility and clinical curative effect of non-pneumoperitoneum suspension surgery with pneumoperitoneum laparoscopic surgery for.elderly patients with colorectal cancer. Methods Eighty-six patients aged ~ 65 years old from June 2011 to June 2016 in our hospital were chosen. The patients suffered from heart and lung disease combined with colorectal cancer. They were divided into non-pneumoperitoneum surgery group and traditional pneumoperitoneum laparoscopic group ,43 in each group. The operative time,intraoperative blood loss, postoperative anal exhaust time, postoperative mean hospitalization day and 2-hour central venous pressure （CVP） as well as arterial blood gas analysis （PaCO2 ） were compared between the two groups. Results There were 3 cases and 2 cases converted to open surgery in the non-pneumoperitoneum and the pneumoperitoneum surgery group,respectively. They were excluded from the study. The remained cases had successful surgeries. There was no death in the two groups. No significant difference in operation time and intraoperative blood loss was found between the two groups （P 〉 0. 05 ）. However, there were significant differences in the exhaust time, postoperative mean hospitalization day, values of 2 hours CVP and PaCO2 between the two groups （P 〈0. 05）. Conclusion The non-pneumoperitoneum suspension surgery expands the laparoscopic surgery indications and avoids the effect of CO2 pneumoperitoneum on heart and lung function. Therefore, non-pneumoperitoneum suspension surgery is an ideal minimally invasive procedure for.these patients.

关 键 词：结直肠癌 无气腹悬吊式手术 腹腔镜 

分 类 号：R656.9[医药卫生—外科学]