摘要
目的研究腹壁悬吊腹腔镜手术治疗结肠癌的预后及术中心肺功能变化。方法采取前瞻性研究,选取我院2011年7月至2014年8月入院的结肠癌患者93例,随机分为悬吊组(腹壁悬吊腹腔镜手术)、气腹组(CO2气腹腹腔镜手术)与开腹组(开腹手术),三组各为31例,经统计学分析证实一般资料无差异后进行对应手术,比较三组患者术后10 min(T1)、30 min(T2)、60min(T3)三个时间点HR(心率)、平均动脉压(MAP)、中心静脉压(CVP)、气道峰压(PIP)、动脉血p H值及动脉血CO2分压(Pa CO2)指标差异,并对预后相关指标及围术期指标进行评价。结果 1三组围术期指标:悬吊组与气腹组比较手术指标比较均无统计学意义(P>0.05),悬吊、气腹组与开腹组比较,手术出血量、排气时间及住院时间显著较低(P<0.05)。2三组心肺功能比较:悬吊组、开腹组手术后T1、T2、T3时间点HR、MAP、CVP、PIP、PH及Pa CO2虽有一定变化,但均处于正常范围,两组组间、组内比较均无统计学意义(P>0.05),气腹组HR未见异常改变,但MAP、CVP、PIP出现明显增高,与另两组比较各时间点均显著较高(P<0.05),T2、T3时Pa CO2开始上升,与同时间点另两组比较显著较高(P<0.05)。3三组预后比较:三组肠梗阻发生率以开腹组较高,但三组比较无统计学意义(P>0.05),局部复发、远处转移及生存率比较均无统计学意义(P>0.05)。结论腹腔镜手术较开放性手术有更高手术安全性,且疗效基本相同,而腹壁悬吊腹腔镜手术较气腹腹腔镜手术对患者心肺功能的影响较小,在确保腔镜手术干预疗效的同时,最大程度保证了手术的安全性,可作为优选方案进行临床应用。
Objective To study the prognosis and the changes of pulmonary function in patients with colon cancer treated by abdominal wall suspension and laparoscopic surgery. Methods It is a prospective study. 93 patients with colon cancer from July 2011 to August 2014 in our hospital were randomly divided into suspension group（Abdominal wall suspension laparoscopic surgery）,pneumoperitoneum group（CO2 pneumoperitoneum laparoscopic surgery） and laparotomy group（open surgery）, 31 cases in every group,all patients were treated aftergeneral information confirmation and then compared the three groups of patients with 10min（T1）, 30min（T2）,60min（T3） three time points HR（heart rate）, mean arterial pressure（MAP）, central venous pressure（CVP）,peak airway pressure（PIP）, arterial blood p H and arterial blood CO2 the pressure difference index（Pa CO2）,and the relevant prognostic indicators and perioperative indicators. Results peri operative index： operation index of suspended group and pneumoperitoneum group had no statistical significance（P〈0.05）, he amount of operative hemorrhage, exhaust time and hospitalization time of suspension group, gasless laparoscopic group were tsignificantly lower than laparotomy group（P〈0.05）. II three groups of heart and lung function： suspension group and laparotomy after T1, T2, T3 time in HR, map, CVP, Pip, p H and Pa CO2 had some changes, but they were all in the normal range, between the two groups, it showed no statistical significance（P〈0.05）, HR of pneumoperitoneum Group had no abnormal change, but map, CVP, PIP had significantly increased,they are higher than the other two groups（P〈0.05）, at T2, T3 Pa CO2 began to rise, it is higher than the other two groups at the same time points（P〈0.05）. prognostic ： incidence rate of intestinal obstruction of laparotomy group were higher, but the three groups had no statistical significance（P〈0.05）, local recurrence, distant metastasis and survival rate of three groups showed
出处
《结直肠肛门外科》
2016年第1期51-54,共4页
Journal of Colorectal & Anal Surgery
关键词
腹壁悬吊
腹腔镜
结肠癌
心肺功能
abdominal wall suspension
Laparoscopy
colorectal cancer
cardiopulmonary function
