目的 观察腹腔镜Miles术联合应用Ligasure的近期疗效。方法 2013-04至2014-12为38例患者行直肠癌Miles术,其中实验组16例(腹腔镜联合LigaSure组),对照组22例(传统开腹组),记录分析两组患者术中情况包括手术总时间、会阴组手术时间、术中出血量;术后情况包括通气时间、术后住院天数、淋巴结清扫数量、会阴部伤口甲级愈合率及术后疼痛评分。结果 实验组少于对照组的有术中总出血量[(125.3±25.9) ml vs(206.3±34.3 )ml]、会阴组手术时间[(26.2±3.4) min vs(35.3±5.2 )min]、通气时间[(51.6±13.9 h)vs(77.4±12.6 h)]、术后住院天数[(11.9±2.6 d)vs(14.7±3.4 d)]和术后疼痛评分[(5.6±2.3 cm)vs(6.9±1.8 cm)], 差异有统计学意义(P<0. 05);而实验组手术总时间(162.6±23.0 min)多于对照组(195.1±27.9 min),差异有统计学意义(P<0. 05)。实验组淋巴结清扫数量(14.3±3.5)与对照组(13.8±3.5)相比,差异无统计学意义。结论 腹腔镜Miles术联合应用Ligasure治疗直肠癌具有术后疼痛轻、恢复快、切口感染率低等优点,且近期疗效好,值得做进一步研究和推广。
Abstract
Objective To observe short-term efficacy of laparoscopic Milestechnique combined with Ligasure. Methods From April 2013 to November.2014,38 patients with rectal cancer undenwent laparoscopic Milestechnique .The patients were divided in to study group (laparoscopic Milestechnique combined with Ligasure, n=16) and control group (open Milestechnique, n=22).The clinical data were recoded and analyzed, including duration of operation ,perineal operation time ,total bleeding volume ,evacuation time ,the postoperetive hospital stays , total lymph nodes clearance , class A regrowth rate of perineal cut and postopretative pain scores. Results The total bleeding volume (125.3±25.9)ml vs (206.3±34.3)ml,perineal operation time(26.2±3.4)min vs (35.3±5.2 min),evacuation time(51.6±13.9) h vs (77.4±12.6)h,the postopertative hospital stays (11.9±2.6 days) vs (14.7±3.4 days) and postoperative pain scores(5.6±2.3 cm) vs (6.9±1.8 cm) in the study group were less than those in the control group(P<0.5).But the duration of operation(162.6±23.0 min)in the study group was longer than that(195.1±27.9 min)in the control group(P<0. 05).The number of total lymph nodes clearance had no signifficant difference between the two groups(P>0.05). Conclusions The laparoscopic Milestechnique combined with Ligasure has better short-term effect including few pain,faster recovery and low wound infection .It is worthy of further promotion and research.
关键词
腹腔镜 /
Miles /
直肠恶性肿瘤 /
LigaSure
Key words
laparoscopy /
Miles /
rectal malignancy /
Ligasure
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参考文献
[1] Mile E. A method of performing abdomino-perineal excision for carcinoma of the rectum and of the terminal portion of the pelvic colon[J].Lancet,1908,2(6):1812-1813.
[2] 郁宝铭.低位直肠癌外科治疗的回顾、现状与展望[J].中华普通外科杂志,2002,17(7):389.
[3] 福永哲,比企直榭,黑柳洋弥,等.LigaSureTM[J].临床外科,2006,61(4):435-440.
[4] Pikarsky A J, Rosenthal R D, Weiss E G, et al. Laparoscopic total mesorectal excision[J] .Surg Endosc, 2002,16 (4) :558-562.
[5] Xiong B, Ma L, Zhang C.Laparoscopic versus open total Mesorectal excision for middle and low rectal cancer: a meta-analysis of results of randomized controlled trials[J].Laparoendosc Adv Surg tech A,2012,22(7): 674-684.
[6] constant D L,Slakey D P,campeau R J,et al.Laparoscopic nonanatomic hepatic resection employing Ligasure TM device[J].JSLS,2005,9(1):35-38.
[7] Matthews B D, Pratt B L, Backus C L, et al.Effectiveness of the ultrasonic coagulating shears,LigaSure vessel sealer,and surgical clip application in biliary surgery:a comparative analysis[J].Am Surg,200l,67(2):90l-906.
[8] 李建平,戴 途,季 源.结扎速血管闭合系统在腹腔镜胆囊切除术中的应用[J].齐齐哈尔医学院学报,2002,23(8):903-904.
[9] Kellokumpu I H,Kairaluoma M I,Nuorva K P,et al. Short-and long-term outcome following laparoscopic versus open resection for carcinoma of the rectum in the multimodal setting[J] . Dis Colon Rectum,2012,55 (8) :854-863.
[10] 张舒龙,工荣演,工振宇,等.腹腔镜结直肠癌于术学习曲线[J].中国微创外科杂志,2013,13 (3) :228-230.
[11] Ito M, Sugito M, Kobayashi A, et al. lnfluence of learning curve on short-term result after laparoscopic resection for rectal cancer[J].Surg Endosc,2009,23(2):403-408.
[12] Boutros M,Hippalgaonkar N, Silva E, et al. Laparoscopic resection of rectal cancer results in higher lymph node yield and better short-term outcomes than open surgery:a large single-center comparative study[J].Dis Colon Rectum, 2013,56 (6) :679-688.
[13] 傅 红,黄 凯,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.
[14] 钱 峻,朱 杰,莫 琪.腹腔镜与开腹直肠癌Miles手术对会阴部伤口愈合的影响[J].中国普外基础与临床杂志,2010,17(10):1017-1020.
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