• 1.暨南大學(xué)第二臨床醫(yī)學(xué)院、深圳市人民醫(yī)院胃腸外科(深圳518020);;
  • 2.華中科技大學(xué)同濟(jì)醫(yī)學(xué)院附屬協(xié)和醫(yī)院普外科(武漢430022);

目的  分析腹腔鏡直腸癌根治術(shù)(LRR)中轉(zhuǎn)開腹手術(shù)對患者術(shù)后恢復(fù)的影響。
方法  回顧性分析深圳市人民醫(yī)院胃腸外科2003年2月至2007年2月期間行LRR的病例208例,其中腹腔鏡中轉(zhuǎn)開腹手術(shù)(CRR)32例,與同期59例開腹直腸癌根治手術(shù)(ORR)和176例成功施行LRR比較,分析手術(shù)時(shí)間、術(shù)后住院時(shí)間、住院費(fèi)用、術(shù)中出血量、腸功能恢復(fù)時(shí)間及并發(fā)癥發(fā)生率情況。
結(jié)果  3種手術(shù)方式之間的手術(shù)時(shí)間、術(shù)后住院時(shí)間、術(shù)中出血量和腸功能恢復(fù)時(shí)間差異均無統(tǒng)計(jì)學(xué)意義(P gt;0.05); CRR和LRR的住院費(fèi)用明顯要高于ORR(P=0.001,P=0.001),而CRR和LRR之間住院費(fèi)用差異無統(tǒng)計(jì)學(xué)意義(P=0.843),但ORR的術(shù)后并發(fā)癥發(fā)生率要高于CRR和LRR(P=0.023,P=0.004)。
結(jié)論  LRR雖然具有一定的中轉(zhuǎn)開腹手術(shù)率,但與ORR相比,CRR并不會影響患者術(shù)后恢復(fù),只是手術(shù)費(fèi)用會增加。

引用本文: 鐘克力,潘凱,夏利剛,李明偉,林烈文,周漢新,王春友. 腹腔鏡直腸癌手術(shù)中轉(zhuǎn)開腹對術(shù)后恢復(fù)的影響. 中國普外基礎(chǔ)與臨床雜志, 2009, 16(4): 311-313. doi: 復(fù)制

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2. Braga M, Vignali A, Gianotti L, et al. Laparoscopic versus open colorectal surgery: a randomized trial on short-term outcome [J]. Ann Surg, 2002; 236(6): 759-767.
3. 卿三華, 巴明臣. 我國腹腔鏡直腸癌根治術(shù)的現(xiàn)狀和展望 [J]. 中國普外基礎(chǔ)與臨床雜志, 2005; 12(6): 540-541.
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5. 池畔, 林惠銘. 腹腔鏡結(jié)直腸癌根治術(shù)學(xué)習(xí)曲線 [J]. 中華胃腸外科雜志, 2004; 7(5): 372-374.
6. Schlachta CM, Mamazza J, Seshadri PA, et al. Defining a learning curve for laparoscopic colorectal resections [J]. Dis Colon Rectum, 2001; 44(2): 217-222.
7. 江志偉, 黎介壽. 結(jié)直腸癌手術(shù)腹腔鏡或開腹術(shù)式選擇的爭論 [J]. 中國實(shí)用外科雜志, 2008; 28(6): 453-455.
8. 鄭民華, 李健文, 陸愛國, 等. 腹腔鏡結(jié)直腸手術(shù)的學(xué)習(xí)曲線 [J]. 外科理論與實(shí)踐, 2002; 7(3): 187-189.
9. 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.
10. Slim K, Pezet D, Riff Y, et al. High morbidity rate after converted laparoscopic colorectal surgery [J]. Br J Surg, 1995; 82(10): 1406-1408.
11. 于永揚(yáng), 王存, 周總光. 腹腔鏡下結(jié)直腸癌手術(shù)(四) [J]. 中國普外基礎(chǔ)與臨床雜志, 2008; 15(7): 533-535.
12. 中華抗癌協(xié)會大腸癌專業(yè)委員會腹腔鏡外科學(xué)組,中華醫(yī)學(xué)會外科學(xué)分會腹腔鏡與內(nèi)鏡學(xué)組. 腹腔鏡結(jié)腸直腸癌根治手術(shù)操作指南(2006版) [J]. 外科理論與實(shí)踐, 2006; 11(5): 462-464.
13. Gervaz P, Pikarsky A, Utech M, et al. Converted laparoscopic colorectal surgery [J]. Surg Endosc, 2001; 15(8): 827-832.
14. Lauter DM, Froines EJ. Initial experience with 150 cases of laparoscopic assisted colectomy [J]. Am J Surg, 2001; 181(5): 398-403.
15. 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.
16. Fukunaga Y, Higashino M, Tanimura S, et al. Laparoscopic colorectal surgery for neoplasm. A large series by a single surgeon [J]. Surg Endosc, 2008; 22(6): 1452-1483.
17. Montreuil B, Bendavid Y. Laparoscopic colorectal surgery in elderly patients: a matched case-control study in 178 patients [J]. J Am Coll Surg, 2008; 207(1): 141-142.
18. Lordan JT, Tilney HS, Shirol S, et al. Does the laparoscopic colorectal surgery learning curve adversely affect the results of colorectal cancer resection? A 3-year prospective study in a district general hospital [J]. Colorectal Dis, 2008; 10(4): 363-369.
19. Jamali FR, Soweid AM, Dimassi H, et al. Evaluating the degree of difficulty of laparoscopic colorectal surgery [J]. Arch Surg, 2008; 143(8): 762-767.
  1. 1. Delaney CP, Kiran RP, Senagore AJ, et al. Case-matched comparison of clinical and financial outcome after laparoscopic or open colorectal surgery [J]. Ann Surg, 2003; 238(1): 67-72.
  2. 2. Braga M, Vignali A, Gianotti L, et al. Laparoscopic versus open colorectal surgery: a randomized trial on short-term outcome [J]. Ann Surg, 2002; 236(6): 759-767.
  3. 3. 卿三華, 巴明臣. 我國腹腔鏡直腸癌根治術(shù)的現(xiàn)狀和展望 [J]. 中國普外基礎(chǔ)與臨床雜志, 2005; 12(6): 540-541.
  4. 4. 李軍, 丁克峰, 張?zhí)K展. 結(jié)直腸癌患者經(jīng)腹腔鏡手術(shù)后短期療效和安全性的薈萃分析 [J]. 中華醫(yī)學(xué)雜志, 2006; 86(35): 2485-2490.
  5. 5. 池畔, 林惠銘. 腹腔鏡結(jié)直腸癌根治術(shù)學(xué)習(xí)曲線 [J]. 中華胃腸外科雜志, 2004; 7(5): 372-374.
  6. 6. Schlachta CM, Mamazza J, Seshadri PA, et al. Defining a learning curve for laparoscopic colorectal resections [J]. Dis Colon Rectum, 2001; 44(2): 217-222.
  7. 7. 江志偉, 黎介壽. 結(jié)直腸癌手術(shù)腹腔鏡或開腹術(shù)式選擇的爭論 [J]. 中國實(shí)用外科雜志, 2008; 28(6): 453-455.
  8. 8. 鄭民華, 李健文, 陸愛國, 等. 腹腔鏡結(jié)直腸手術(shù)的學(xué)習(xí)曲線 [J]. 外科理論與實(shí)踐, 2002; 7(3): 187-189.
  9. 9. 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.
  10. 10. Slim K, Pezet D, Riff Y, et al. High morbidity rate after converted laparoscopic colorectal surgery [J]. Br J Surg, 1995; 82(10): 1406-1408.
  11. 11. 于永揚(yáng), 王存, 周總光. 腹腔鏡下結(jié)直腸癌手術(shù)(四) [J]. 中國普外基礎(chǔ)與臨床雜志, 2008; 15(7): 533-535.
  12. 12. 中華抗癌協(xié)會大腸癌專業(yè)委員會腹腔鏡外科學(xué)組,中華醫(yī)學(xué)會外科學(xué)分會腹腔鏡與內(nèi)鏡學(xué)組. 腹腔鏡結(jié)腸直腸癌根治手術(shù)操作指南(2006版) [J]. 外科理論與實(shí)踐, 2006; 11(5): 462-464.
  13. 13. Gervaz P, Pikarsky A, Utech M, et al. Converted laparoscopic colorectal surgery [J]. Surg Endosc, 2001; 15(8): 827-832.
  14. 14. Lauter DM, Froines EJ. Initial experience with 150 cases of laparoscopic assisted colectomy [J]. Am J Surg, 2001; 181(5): 398-403.
  15. 15. 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.
  16. 16. Fukunaga Y, Higashino M, Tanimura S, et al. Laparoscopic colorectal surgery for neoplasm. A large series by a single surgeon [J]. Surg Endosc, 2008; 22(6): 1452-1483.
  17. 17. Montreuil B, Bendavid Y. Laparoscopic colorectal surgery in elderly patients: a matched case-control study in 178 patients [J]. J Am Coll Surg, 2008; 207(1): 141-142.
  18. 18. Lordan JT, Tilney HS, Shirol S, et al. Does the laparoscopic colorectal surgery learning curve adversely affect the results of colorectal cancer resection? A 3-year prospective study in a district general hospital [J]. Colorectal Dis, 2008; 10(4): 363-369.
  19. 19. Jamali FR, Soweid AM, Dimassi H, et al. Evaluating the degree of difficulty of laparoscopic colorectal surgery [J]. Arch Surg, 2008; 143(8): 762-767.