摘要
目的:探讨腹腔镜下Miles术式在折刀位与截石位治疗低位直肠癌的近期临床疗效。方法:回顾性分析青岛大学附属医院2017年1月至2021年7月于腹腔镜下行Miles手术治疗的214例低位直肠癌患者临床资料,按照手术体位不同将患者分为两组,折刀位组55例,截石位组159例。按1:2倾向性评分匹配后两组共纳入165例进行后续分析。观察比较两组手术相关指标、术后引流管引流量、术后胃肠道功能恢复情况、术后血液检查结果、术后早期并发症情况、切除标本病理学检查结果。结果:折刀位组手术中出血量少于截石位组,且差异具有统计学意义(t=-4.05,P<0.05),术后会阴部切口引流管第一天引流量(Z=-2.10,P<0.05)、第二天引流量(Z=-2.46,P<0.05)、第三天引流量(Z=-2.39,P<0.05)均少于截石位组引流量,差异具有统计学意义;术后炎症指标C反应蛋白(CRP)最高值低于截石位患者,差异具有统计学意义(t=-2.38,P<0.05);术后患者出院会阴部带引流管率差异具有统计学意义(χ^(2)=4.76,P<0.05)。结论:从近期的临床疗效来看腹腔镜下低位直肠癌Miles手术折刀位与截石位组总体上差异无统计学意义,但前者术中出血量较少,术后创面渗出较少,术后炎症反应轻,对患者术后恢复具有一定的优势。
Objective To analyze the short-term clinical efficacy of laparoscopic Miles'surgery in prone jackknife position and traditional lithotomy position for low rectal cancer.Methods The clinical data of 214 patients with low rectal cancer treated by laparoscopic Miles'surgery from January 2017 to July 2021 in The Affiliated Hospital of Qingdao University were retrospectively analyzed.According to different surgical position,all patients was divided into 55 patients in the prone jackknife position group and 159 patients in the traditional lithotomy position group.A total of 165 cases were included in the two groups after 1:2 tendency score matching for subsequent analysis.The following data were compared between the two groups:surgical related indicators,postoperative drainage tube drainage,postoperative gastrointestinal function recovery,postoperative blood examination results,early postoperative complications,and pathological examination results of the resection specimens.Results The amount of bleeding in the laparoscopic lower rectal cancer prone jackknife position group was less than that in the traditional lithotomy position group(t=-4.05,P<0.05).The drainage flow of the first day(Z=-2.10,P<0.05),the second day(Z=-2.46,P<0.05)and the third day(Z=-2.39,P<0.05)in the prone jackknife position group were less than that of the traditional lithotomy position group.The highest C reactive protein(CRP)value of postoperative inflammation index in the prone jackknife position group was lower than that of patients with the traditional lithotomy position group(t=-2.38,P<0.05).The postoperative discharge rate was statistically significant(χ^(2)=4.76,P<0.05).Conclusion From the short-term clinical efficacy,there was no significant difference in the laparoscopic Miles'surgical prone jackknife position for low rectal cancer and the traditional lithotomy group,but the former has less intraoperative bleeding,less postoperative wound exudation and less postoperative inflammation,which has certain advantages for postoperative recover
作者
刘曙光
宋彦呈
李兆鹏
李兆
郭栋
袁辰桐
陈栋
牛兆建
李宇
Shuguang Liu;Yancheng Song;Zhaopeng Li;Zhao Li;Dong Guo;Chentong Yuan;Dong Chen;Zhaojian Niu;Yu Li(Department of Gastrointestinal Surgery,Affiliated Hospital of Qingdao University,Qingdao 266003,China)
出处
《中华结直肠疾病电子杂志》
2023年第4期303-310,共8页
Chinese Journal of Colorectal Diseases(Electronic Edition)
基金
山东省医药卫生科技发展计划项目(No.202204010913)。
关键词
直肠肿瘤
腹腔镜
低位直肠癌
俯卧折刀位
传统截石位
MILES手术
Rectal neoplasms
Laparoscopes
Low rectal cancer
Prone jackknife position
Traditional lithotomy position
Miles'operation
