中国普外基础与临床杂志

中国普外基础与临床杂志

腹腔镜与开腹直肠癌Miles手术对会阴部伤口愈合的影响

查看全文

目的 比较腹腔镜辅助与开腹直肠癌Miles根治术对会阴部伤口愈合的影响。
方法 收集2008年1月至2009年12月期间我院行腹腔镜Miles根治术的54例(腹腔镜组)及行开腹Miles根治术的48例(开腹组)直肠癌患者的临床资料,比较2组患者会阴部伤口的甲级愈合率、全程手术时间、会阴部手术时间、术中出血量、术后骶前引流量及术后第3天血白蛋白水平的差异。
结果 2组患者在性别、年龄、肿瘤Dukes分期、术前白蛋白水平及术前合并症方面差异均无统计学意义(Pgt;0.05)。腹腔镜组的会阴部伤口甲级愈合率(χ2=5.54,Plt;0.05)及术后第3天血白蛋白水平(t=3.92, Plt;0.01)均明显高于开腹组。腹腔镜组会阴部手术时间(t=6.64,Plt;0.01)、术中出血量(t=6.05, Plt;0.01)和术后骶前引流量(t=12.86,Plt;0.01)均明显短于或少于开腹组。
结论 腹腔镜辅助Miles根治术较开腹Miles手术具有更高的会阴部伤口甲级愈合率,这可能与腹腔镜手术创伤小、出血少及会阴部手术时间更短有关。

Objective To compare the effects between laparoscopic and conventional open abdominal approaches on perineal wound healing for patients with rectal cancer.
Methods The clinical data of 54 patients undergoing laparoscopic abdominal perineal resection (laparoscopy group) and 48 patients undergoing open abdominal perineal resection (open group) between January 2008 and December 2009 in this hospital were collected. Parameters including class A healing rate of perineal wound, duration of surgery, duration of perineal resection, blood loss during operation, anterosacral drainage, and serum albumin level on day 3 after surgery were compared between two groups.
Results There was no significant difference of gender, age, tumor Dukes stage, preoperative albumin, or preoperative complications between two groups (Pgt;0.05). The class A healing rate of perineal wound (χ2=5.54, Plt;0.05) and serum albumin level on the third day after surgery (t=3.92, Plt;0.01) in the laparoscopy group was significantly higher than those in the open group. In the laparoscopy group, duration of perineal resection (t=6.64, Plt;0.01), blood loss during operation (t=6.05, Plt;0.01), and anterosacral drainage (t=12.86, Plt;0.01) were less than those in the open group.
Conclusion The higher class A healing rate of laparoscopic approach for the patients with rectal cancer might be associated with the minimal invasiveness, less blood loss, and shorter duration.

关键词: 腹腔镜手术; 直肠癌; 会阴; 切口愈合

Key words: Laparoscopy; Rectal cancer; Perineum; Wound healing

引用本文: 钱峻,朱杰,莫琪,汤黎明. 腹腔镜与开腹直肠癌Miles手术对会阴部伤口愈合的影响. 中国普外基础与临床杂志, 2010, 17(10): 1017-1020. doi: 复制

登录后 ,请手动点击刷新查看全文内容。 没有账号,
1.  Guillou PJ, Quirke P, Thorpe H, et al. Short-term endpoints of conventional versus laparoscopic-assisted surgery in patients with colorectal cancer (MRC CLASICC trial): multicentre, randomised controlled trial [J]. Lancet, 2005; 365(9472): 1718-1726.
2.  Clinical Outcomes of Surgical Therapy Study Group. A comparison of laparoscopically assisted and open colectomy for colon cancer [J]. N Engl J Med, 2004; 350(20): 2050-2059.
3.  陈峻青, 夏至平. 胃肠癌根治手术学  [M]. 北京: 人民卫生出版社, 2001: 3.
4.  Artioukh DY, Smith RA, Gokul K. Risk factors for impaired healing of the perineal wound after abdominoperineal resection of rectum for carcinoma [J]. Colorectal Dis, 2007; 9(4): 362-367.
5.  Aziz O, Constantinides V, Tekkis PP, et al. Laparoscopic versus open surgery for rectal cancer: a meta-analysis [J]. Ann Surg Oncol, 2006; 13(3): 413-424.
6.  傅红, 黄恺, 史向军. 直肠癌腹会阴联合根治术后会阴切口临床处理进展 [J]. 世界华人消化杂志, 2008; 16(1): 1-4.
7.  甘露, 张超, 曾冬竹, 等. 结直肠癌患者腹腔镜手术与开腹手术后并发症的风险因素分析 [J]. 第三军医大学学报, 2008; 30(17): 1668-1670.
8.  张建立, 邱志刚, 王正坤. 腹腔镜直肠癌根治术围手术期机体营养代谢的研究 [J]. 腹腔镜外科杂志, 2007; 12(2):115-117.
9.  杨硕, 张建立. 腹腔镜与开腹结直肠癌根治术对机体免疫系统影响的比较研究 [J]. 腹腔镜外科杂志, 2008; 13(1): 22-24.
10.  叶颖江, 王杉, 和宇, 等. 结直肠癌手术部位感染相关并发症影响因素分析 [J]. 中国普通外科杂志, 2006; 21(2): 122-124.
11.  王亮, 傅卫, 任立焕, 等. 腹会阴联合直肠癌切除术后会阴伤口感染的危险因素分析 [J]. 中华普通外科杂志, 2008; 23(9): 716-717.
12.  钱洪军, 易伟, 陈范昶. 直肠癌Miles手术不同骶前引流方法对会阴部切口愈合的影响 [J]. 江西医学院学报, 2006; 46(3): 111-113.
13.  刘宗荣, 朱易凡, 马淙, 等. 结直肠癌手术后感染并发症的调查和分析 [J]. 中国普通外科杂志, 2008; 17(1): 104-106.
14.  陈世君, 王勇强. 预防性使用抗生素时间与结直肠癌手术切口感染的关系 [J]. 中国普外基础与临床杂志, 2010; 17(1): 73-76.
15.  刘小健, 李君, 陈利生. 直肠癌Miles术后影响会阴部切口愈合的多因素分析 [J]. 结直肠肛门外科, 2008; 14(5): 301-304.
16.  Delaney CP, Lynch AC, Senagore AJ, et al. Comparison of robotically performed and traditional laparoscopic colorectal surgery [J]. Dis Colon Rectum, 2003; 46(12): 1633-1639..
17.  梁辉, 管蔚, 陈国玉. 不同年龄直肠癌患者行腹腔镜与行开腹根治术的比较 [J]. 中国普外基础与临床杂志, 2009; 16(10): 789-792.
18.  范莹, 吴硕东, 于宏, 等. 腹腔镜结直肠癌根治术与同期开腹手术对比的单中心回顾性研究 [J]. 中国普外基础与临床杂志, 2009; 16(5): 384-388.
19.  王振宁, 邢承忠, 鲁翀, 等. 超声刀在开放结直肠癌根治手术中的应用 [J]. 中国普外基础与临床杂志, 2008; 15(10): 714-717.
20.  杨俊省, 张建立. 腹腔镜直肠癌Miles手术对机体应激反应和内脏蛋白的影响 [J]. 腹腔镜外科杂志, 2009; 14(12): 922-924.
21.  李太原, 刘东宁, 戴安邦, 等. 腹腔镜下直肠癌根治术对机体免疫功能的影响 [J]. 江西医学院学报, 2009; 49(3): 109-110, 114.
22.  曹其彬, 胡三元. 腹腔镜下结直肠癌手术对机体免疫功能的影响 [J]. 结直肠肛门外科, 2006; 12(5): 278-281.
23.  王贵和, 赵铁军, 束宽山, 等. 腹腔镜直肠癌根治术对机体的炎性反应及免疫功能的影响 [J]. 腹部外科, 2007; 20(6): 354-355.
24.  Evans C, Galustian C, Kumar D, et al. Impact of surgery on immunologic function: comparison between minimally invasive techniques and conventional laparotomy for surgical resection of colorectal tumors [J]. Am J Surg, 2009; 197(2): 238-245.
25.  田文, 李荣, 陈凛. 结直肠癌腹腔镜切除术对机体应激反应影响的临床研究 [J]. 中国普外基础与临床杂志, 2004; 11(3): 204-208.