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中华结直肠疾病电子杂志

中华结直肠疾病电子杂志 ›› 2017, Vol. 06 ›› Issue (05) : 377 -380. doi: 10.3877/cma.j.issn.2095-3224.2017.05.005

所属专题： 文献；

论著

根治性左半结肠切除术腹腔镜组与开腹组的短期临床研究
陶金华1, 刘骞1,†(), 刘正1, 裴炜1, 姜争1, 郭春光2, 陈佳楠1, 冷亚飞3   
  1. 1. 北京　100021，国家癌症中心/中国医学科学院北京协和医学院肿瘤医院结直肠外科
    2. 北京　100021，国家癌症中心/中国医学科学院北京协和医学院胰胃外科
    3. 贵州　565100，贵州省思南县人民医院普外科
  • 收稿日期:2017-03-19 出版日期:2017-10-25
  • 通信作者: 刘骞
  • 基金资助:
    国家重点研发计划精准医学专项资助项目(No.2016YFC905301)

Comparison study of laparoscopic (LAP) surgery vs. open surgery (OS) for descending colon cancer

Jinhua Tao1, Qian Liu1,†(), Zheng Liu1, Wei Pei1, Zheng Jiang1, Chunguang Guo2, Jianan Chen1, Yafei Leng3   

  1. 1. Department of Colorectal Surgery, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
    2. Department of Pancreatic Stomach Surgery, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
    3. Department of General Surgery, Sinan People′s Hospital, Guizhou 565100, China
  • Received:2017-03-19 Published:2017-10-25
  • Corresponding author: Qian Liu
  • About author:
    Corresponding author: Liu Qian, Email:
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引用本文：

陶金华, 刘骞, 刘正, 裴炜, 姜争, 郭春光, 陈佳楠, 冷亚飞. 根治性左半结肠切除术腹腔镜组与开腹组的短期临床研究[J]. 中华结直肠疾病电子杂志, 2017, 06(05): 377-380.

Jinhua Tao, Qian Liu, Zheng Liu, Wei Pei, Zheng Jiang, Chunguang Guo, Jianan Chen, Yafei Leng. Comparison study of laparoscopic (LAP) surgery vs. open surgery (OS) for descending colon cancer[J]. Chinese Journal of Colorectal Diseases(Electronic Edition), 2017, 06(05): 377-380.

目的

评价根治性左半结肠切除术腹腔镜组（LAP）与开腹组（OS）在短期手术疗效方面的差异。

方法

回顾性分析中国医学科学院肿瘤医院结直肠外科2010年1月至2016年3月实施的144例左半结肠切除术的临床资料，其中腹腔镜组66例，开腹组患者78例，对两组患者术中及术后结果进行比较。

结果

腹腔镜组手术时间（151.36±26.98）min与开腹组手术时间（190.30±15.30）min相比差异有统计学意义（t=-5.130，P=0.0014）；腹腔镜组术中平均出血量（75.00±24.59）ml与开腹组（76.87±29.92）ml比较差异无统计学意义（t=-0.836，P=0.4613）。腹腔镜组手术切口平均（6.88±3.00）cm，与开腹组（15.57±2.22）cm相比差异有统计学意义（t=-28.484，P<0.001）；腹腔镜组淋巴结清扫数目（21.58±8.57）个，与开腹组（23.82±10.96）个相比，差异无明显统计学意义（t=-0.283，P=0.2670）。腹腔镜组患者术后下床时间、排气时间、进食时间较开腹组患者均明显缩短（均P<0.05）；腹腔镜组患者住院时间[（14.19±4.80）天]较开腹组[（17.21±2.38）天]缩短（t=-3.762，P=0.0364）。两组术后并发症差异无统计学意义。

结论

腹腔镜左半结肠切除术安全可靠，与传统开腹手术相比具有手术时间短、手术切口小、术后恢复快、住院时间短等优势。

关键词: 结直肠肿瘤, 腹腔镜, 外科手术，微创性, 开腹手术
Objective

To evaluate short-time outcomes of laparoscopic surgery and open surgery (OS) for left-sided colon cancer.

Methods

Clinical data of 144 patients who received LAP or OS left hemicolectomy in Chinese Academy of Medical Science and Peking Union Medical College from January 2010 to March 2016 were collected and analyzed. These patients were divided into LAP group (n=66) and OS group (n=78). The operation time, intraoperative blood loss, the number of dissected lymph nodes and short-time outcomes were compared between two groups.

Results

There was a significant difference in operating time between the LAP group (151.36±26.98) min and the OS group (190.30±15.30) min (t=-5.130, P=0.0014). There was no significant difference in intraoperative blood loss between the LAP group (75±29.92) ml and the OS group (76.87±24.59) ml (t=-0.836, P=0.4613). There was a significant difference in length of surgical incision between the LAP group (6.88±3.00) cm and the OS group (15.57±2.22) cm (t=-28.484, P<0.001).There was no significant difference in number of swollen lymph nodes between the LAP group (21.58±8.57) and the OS group (23.82±10.96) (t=-0.283, P=0.2670). The average postoperative evacuation time (P=0.0015), getting out-of-bed time (P=0.0009), time to eat food (P=0.0018) were shorter in LAP group than in OS group.The hospital stays were shorter in LAP group than in OS group (t=-3.762, P=0.0364). there was no statistically significant difference between the two groups in postoperative complications (P=0.333).

Conclusions

LAP for left sided colon cancer is safe and reliable. Compared to the OS group, LAP has advantages including less surgery time, smaller surgical incision, faster recovery and shorter hospital stays.

Key words: Colorectal neoplasms, Laparoscopes, Surgical procedures, minimally invasive, Laparotomy
表1 LAP组和OS组一般资料
组别 LAP组 OS组 t/Χ2值 P值
例数 78 66
性别（例） 0.004 0.952
男 54 46
女 24 20
年龄（岁，±s） 55.00±11.05 56.54±8.24 -0.012 0.6188
肿瘤大小（cm，±s） 3.00±1.40 3.40±2.10 -0.383 0.6210
肿瘤距肛位置（cm，±s） 42.30±3.10 45.10±1.60 -2.496 0.8320
病理类型（例） 1.0000
腺癌 77 66
粘液腺癌 1 0
分期(例) 0.279 0.7318
Ⅰ 8 4
Ⅱ 28 24
Ⅲ 42 38
表2 LAP组和OS组手术相关指标比较（±s，例)
参数 LAP（n=78） OS（n=66） t值 P值
手术时间（min） 151.36±26.98 190.30±15.30 -5.130 0.0014
出血量（ml） 75±24.59 76.87±29.92 -0.836 0.4613
手术切口（cm） 6.88±3.00 15.57±2.22 -28.484 0.0000
清扫淋巴结总数（个） 21.58±8.57 23.82±10.96 -0.283 0.2670
阳性淋巴结数（个） 1.79±2.85 1.31±1.22 1.315 0.3370
术后排气时间（h） 77.41±19.36 131.52±20.47 -44.561 0.0015
术后下床时间（h） 84.23±21.18 140.26±18.70 -41.473 0.009
术后进食时间（h） 97.23±20.43 151.88±24.50 -48.331 0.0018
住院天数（d） 14.19±4.80 17.21±2.38 -3.762 0.0364
表3 LAP组和OS组术后并发症情况（例）
项目 LAP组（78） OS组（66） P值
手术并发症（例） 1 3 0.333
肠梗阻 1 2
切口感染 0 1
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