【作者】 常明鑫；

【导师】 田力；

【作者基本信息】 吉林大学 ， 外科学， 2009， 硕士

【摘要】 目的:评价腹腔镜结直肠癌手术的可行性及安全性。方法:本研究对2004-2008年我院收治的48例结直肠癌患者的术后早期临床资料做回顾性分析,其中21例行腹腔镜结直肠手术,27例行同期开腹手术。两组病例的临床资料无明显差异。入组标准:术前经结肠镜及活检病理检查证实为结直肠癌,术前评估可行根治手术者,且均无肠梗阻、邻近脏器肿瘤侵及(通过直肠指诊及术前腹部彩超、CT证实)及无其他腹部手术史。采用临床对照研究的方法,针对腹腔镜组和开腹组的手术时间、术中出血量、术后一般情况、手术淋巴结清除数(术后病理)、手术并发症、胃肠功能恢复情况、术前术后血糖、体温、白细胞、疼痛视觉模拟评分(VAS)等情况进行对照分析,以确定腹腔镜手术治疗结直肠癌的可行性及安全性。结果:腹腔镜结直肠癌根治手术均顺利完成,无术中术后严重并发症和手术死亡病例,无中转开腹例数。腹腔镜组年龄、性别、肿瘤部位、肿瘤分期及手术时间等与开腹组差异无显著意义(P>0.05);腹腔镜手术患者术中出血、术后肠鸣音恢复时间、排气时间、留置胃管、术后进食、术后排便等均显著优于开腹组(P<0.01);两组术后第1天血糖明显升高,腹腔镜组术后第2天恢复到术前水平,开腹组术后第3天恢复至术前水平,且术后第1天(术后24小时)组间差异有统计学意义(P<0.01);两组术前、术后3、5天体温变化、白细胞计数相比较均无显著性差异(P>0.05);术后l天体温变化、白细胞计数,术后1、3、5天视觉模拟评分(VAS)测定结果两组均存在显著性差异(P<0.01,P<0.05);腹腔镜组手术切除标本长度为(21.77±3.50)cm,清扫肠旁淋巴结、系膜间淋巴结、血管根部淋巴结以及淋巴结总数为(10.8±1.6)枚与开腹组(11.3±2.3)无显著差异(P>0.05)。结论:1.腹腔镜结直肠癌根治手术是安全可行的。2.腹腔镜结直肠癌根治手术具备微创手术的优势。3.腹腔镜结直肠癌根治手术能够遵守肿瘤学根治性原则。更多还原

【Abstract】 Colorectal cancer is a common digestive tract cancer, surgical treatment is still the core of their means of treatment. Laparoscopic treatment of colorectal malignancies is the beginning of the last century 90’s new technologies.Laparoscopic surgery with small incision, the gastrointestinal tract to stimulate the small, rapid recovery of gastrointestinal function, immune function affected by the small, intraoperative and postoperative complication rate is low, postoperative pain, faster postoperative recovery, shorter length of stay in hospital , after the earlier to accept the advantages of other forms of treatment in clinical practice for many years has been gradually accepted by people outside the industry. Laparoscopic surgery for the treatment of malignant tumors still remains controversial value, such as laparoscopic surgery incision tumor after planting and can achieve radical tumor effects.Used in this study on laparoscopic surgery for colorectal cancer, postoperative stress response, postoperative recovery of gastrointestinal function, postoperative complications, such as evaluation, and the laparotomy group with the same period of comparison, laparoscopic colorectal cancer radical tumor surgery of the safety, effectiveness and feasibility.Objective: To evaluate the laparoscopic colorectal surgery the feasibility and safety. Methods: 2004-2008 In this study, our hospital, 47 cases of colorectal cancer in patients with early postoperative clinical data to do a retrospective analysis of 21 routine laparoscopic colorectal surgery, 27 routine laparotomy in the same period.The clinical data of two groups no significant difference. Into the group of standards; preoperative colonoscopy and biopsy, as confirmed by pathological examination in colorectal cancer, preoperative evaluation of radical surgery possible, and no emergency abdominal surgery, intestinal obstruction, near the organ and tumor invasion (by digital rectal examination and surgery before the abdominal color Doppler ultrasound, CT confirmed) and the history of colorectal surgery. Clinical comparative study of the use of the method, for the laparoscopic group and open group of operative time, bleeding volume, the general situation after surgery to remove a few lymph nodes (pathological), surgical complications, the recovery of gastrointestinal function, surgery before and after blood sugar, body temperature, WBC, pain visual analogue score (VAS), such as comparative analysis conducted to determine the treatment of colorectal laparoscopic surgery the feasibility and safety.Results: The laparoscopic radical operation of colorectal cancer are successfully completed, no serious complications after surgery and surgical deaths and no cases of conversion. Laparoscopic group age, sex, tumor site, tumor stage and time with the open surgery group was no significant difference (P> 0.05); bleeding in patients with laparoscopic surgery, postoperative recovery time bowel sound, exhaust time , indwelling stomach tube, after eating and after defecation significantly better than all conventional group (P <0.01); the two groups after day 1 was significantly increased blood glucose, laparoscopic group the first two days after return to preoperative levels, open group of the first three days after return to preoperative levels, and one day after the first group There was a significant difference between (P <0.01); the two groups of preoperative and postoperative changes in body temperature of 3,5 days, compared to white blood cell count were not significantly different (P> 0.05); after l-day changes in body temperature, white blood cell count, postoperative visual analogue score 1,3,5 days (VAS) measurements in both groups, there was a significant difference (P <0.01, P <0.05); laparoscopic group length of surgical resection specimens (21.77±3.50) cm, intestinal lymph nodes dissection, lymph nodes between mesangial, vascular roots of the total number of lymph nodes and lymph nodes (10.8±1.6) gold and open group (11.3±2.3) no significant difference (P> 0.05).Conclusion: 1. Laparoscopic radical operation of colorectal cancer is safe and feasible. 2. Laparoscopic radical operation of colorectal cancer with the advantages of minimally invasive surgery. 3. Laparoscopic radical operation for colorectal cancer can comply with the principle of radical oncology.更多还原