腹腔镜与经骶尾部入路手术治疗良性直肠后肿瘤的比较  

Comparison of Laparoscopic Approach Versus Traditional Trans-sacrococcygeal Approach for Benign Retrorectal Tumors

作　　者：周皎琳[1] 吴斌[1] 邱辉忠[1] 王琦璞 肖毅[1] 林国乐[1] 陆君阳[1] 孙曦羽[1] 牛备战[1] 张冠南[1] 徐徕[1] Zhou Jiaolin;Wu Bin;Qiu Huizhong(Department of General Surgery,Peking Union Medical College Hospital,Peking Union Medical College,Chinese Academy of Medical Sciences,Beijing 100730,China)

机构地区：[1]中国医学科学院北京协和医院基本外科,北京100730

出　　处：《中国微创外科杂志》2018年第9期769-773,共5页Chinese Journal of Minimally Invasive Surgery

摘　　要：目的探讨腹腔镜与经骶尾部入路手术治疗良性直肠后肿瘤的疗效。方法回顾分析1990年9月~2015年9月我科行腹腔镜(腹腔镜组,n=32)或经骶尾部入路(经骶尾入路组,n=36)手术治疗良性直肠后肿瘤的临床资料,对2种术式的手术时间、术中出血量、围手术期并发症、术后住院时间及术后肿瘤残留或复发情况进行比较。结果腹腔镜组与骶尾入路组手术时间分别为(124±54)、(105±45)min,无统计学差异(t=-1.582,P=0.118);术中出血量中位数分别为30 ml(5~200 ml)、50 ml(10~800 ml),无统计学差异(Z=-1.575,P=0.115);迟发性直肠穿孔发生率分别为6.3%(2/32)、0(0/36),无统计学差异(P=0.218)。腹腔镜组切口感染率0(0/32),明显低于骶尾入路组16.7%(6/36)(P=0.026);术后住院时间(6±3)d,明显短于骶尾入路组(9±5)d(t=2.953,P=0.004)。2组术后肿瘤残留或复发率分别为9.4%(3/32)、5.6%(2/36),无统计学差异(χ~2=0.019,P=0.891)。结论对于经过筛选的良性直肠后肿瘤,腹腔镜手术为传统经骶尾部入路手术提供一种可行的替代术式,具有肿瘤头侧显露好、解剖更精细、切口并发症少、术后恢复快等优点。Objective To compare clinical outcomes of laparoscopic versus trans-sacrococcygeal approach for benign retrorectal tumors. Methods Clinical data of patients with benign retrorectal tumors undergoing either laparoscopic or transsacrococcygeal surgery in our department from September 1990 to September 2015 were retrospectively reviewed and analyzed. Outcome measures including the operating time,intraoperative blood loss,perioperative complications,postoperative hospital stay,and tumor recurrence or residual rate of the two surgical approaches were compared. Results There were no significant differences between the laparoscopic group and the trans-sacrococcygeal group in the operative time [（ 124 ± 54） min vs.（ 105 ± 45） min,t =-1. 582,P =0. 118] and the median intraoperative blood loss [30 ml（ range,5-200 ml） vs. 50 ml（ range,10 - 800 ml）,Z =-1. 575,P =0. 115]. The incidence of delayed rectal wall perforation was 6. 3%（ 2/32） in the laparoscopic group and 0（ 0/36） in the transsacrococcygeal group,without statistical difference（ P = 0. 218）. As compared to the trans-sacrococcygeal group,the laparoscopic group had significantly lower rate of surgical wound infection [0（ 0/32） vs. 16. 7%（ 6/36）,P = 0. 026] and shorter postoperative hospital stay [（ 6 ± 3） d vs.（ 9 ± 5） d,t = 2. 953,P = 0. 004]. There was no significant difference between the two groups in tumor residual or recurrence rate [9. 4%（ 3/32） vs. 5. 6%（ 2/36）,χ^2= 0. 019,P = 0. 891]. Conclusion Laparoscopic approach provides a feasible alternative to the trans-sacrococcygeal approach for the management of benign retrorectal tumors in selected patients,with the advantages of better visualization of the cephalic part of the tumor,more precise surgical dissection,less wound complications and faster postoperative recovery.

关 键 词：直肠后肿瘤 骶前肿瘤 腹腔镜 经骶尾部入路 

分 类 号：R735.37[医药卫生—肿瘤]