摘要
目的探讨3D腹腔镜经肛全直肠系膜切除术(transanal total mesorectal excision,TaTME)中场景式扶镜法的可行性。方法以流程图的形式制定场景式3D腹腔镜TaTME扶镜技术,2018年11月~2019年4月,30例直肠癌在3D腹腔镜TaTME中采用场景式扶镜技术(场景式组),2017年11月~2018年10月,33例3D腹腔镜TaTME中采用传统扶镜法(传统组),对2组手术时间、术中出血量等进行对比分析。结果场景式组手术时间(63.8±18.1)min,明显短于传统组(78.5±20.8)min(t=2.960,P=0.004);出血量(39.5±18.4)ml,明显少于传统组(74.0±22.1)ml(t=6.690,P=0.000)。场景式组和传统组淋巴结清扫数目分别为(11.9±4.4)、(13.8±4.8)枚,术后住院时时间分别为(10.4±2.4)、(9.8±5.7)d,术后并发症分别为3、5例,均无统计学差异(P>0.05)。2组术后随访3~12个月,场景组1例局部复发。结论场景式扶镜法在3D腹腔镜TaTME中相较于传统扶镜法可缩短手术时间、减少术中出血,术者可获得更清晰的手术视野和更开阔的手术空间以及更佳的操作流畅性。
Objective To analyze the feasibility of the scene-guided camera assistance in 3D laparoscopic transanal total mesorectal excision(TaTME)for low rectal cancer.Methods The technique of the laparoscope manipulation was demonstrated with the flow charts.A total number of 63 consecutive patients were enrolled in the study,with 33 patients operated with traditional camera assistance(surgeon-guided group)from November 2017 to October 2018 and 30 patients operated with scene-guided camera assistance(scene-guided group)from November 2018 to April 2019,respectively.The operation time and blood loss were compared.Results The operation time of the scene-guided group was(63.8±18.1)min,which was significantly less than that of the surgeon-guided group[(78.5±20.8)min,t=2.960,P=0.004].The intraoperative bleeding volume of the scene-guided group[(39.5±18.4)ml]was significantly less than that of the surgeon-guided group[(74.0±22.1)ml,t=6.690,P=0.000].The number of lymph node dissections in the scene-guided group and surgeon-guided group were(11.9±4.4)and(13.8±4.8),respectively.The time of hospitalization after operation was(10.4±2.4)and(9.8±5.7)days,and complications after operation occurred in 3 and 5 cases,respectively,without statistical differences(P>0.05).Two groups were followed up for 3-12 months,and there was 1 case of local recurrence in the scene-guided group.Conclusion Compared with the surgeon-guided approach,the scene-guided camera assistance can shorten the operation time and reduce the intraoperative bleeding,and the operator can obtain clearer surgical vision and wider surgical space as well as better performance fluency in 3D laparoscopic TaTME for low rectal cancer.
作者
刘见
彭孟寅
左强
吴淼
Liu Jian;Peng Mengyin;Zuo Qiang(Department of Gastrointestinal and Hernia Surgery,Second People’s Hospital of Yibin,Yibin 644000,China)
出处
《中国微创外科杂志》
CSCD
北大核心
2020年第10期915-919,共5页
Chinese Journal of Minimally Invasive Surgery
关键词
场景式
3D腹腔镜
经肛全直肠系膜切除术
扶镜手
Scene-guided
3D laparoscopy
Transanal total mesorectal excision
Camera assistant
