摘要
目的探讨膜解剖理念在腹腔镜直肠癌根治术中的临床效果。方法选取2023年4月~2024年4月我院33例膜解剖理念下行腹腔镜直肠癌根治术(观察组),与2022年3月~2023年3月35例传统下完全直肠系膜理念下行腹腔镜直肠癌根治术(对照组)进行回顾性比较,比较2组患者手术相关指标(手术时间、术中出血量、淋巴结清扫数等)及术后恢复情况。结果观察组和对照组患者手术时间分别为(173.8±14.7)、(179.1±15.3)min,差异无统计学意义(t=-1.437,P=0.156);2组术后住院时间(9.4±1.4)d、(9.8±2.4)d(t=-0.859,P=0.394)和并发症发生率[12.1%(4/33)vs.20.0%(7/35),χ^(2)=0.778,P=0.378]差异均无显著性。观察组术中出血量(34.6±10.8)ml,显著少于对照组(81.0±14.3)ml(t=-15.156,P=0.000);观察组淋巴结清扫数目(19.8±1.3)枚,显著多于对照组(12.4±1.9)枚(t=18.684,P=0.000);观察组术后首次排气时间(50.4±6.5)h,显著短于对照组(55.2±8.9)h(t=-2.557,P=0.013);观察组术后腹腔引流时间(5.9±1.1)d,明显短于对照组(6.5±1.0)d(t=-2.532,P=0.014)。66例随访8~39个月,中位时间25个月,观察组无转移、局部复发和无死亡,对照组肝转移1例,局部复发1例,其他系统疾病死亡1例。结论膜解剖理念应用在腹腔镜直肠癌根治术中,在完整切除直肠系膜的基础上能够有效扩大手术视野,减少术中出血,提高淋巴结清扫率,从而提升手术质量,但未能缩短手术时间。
Objective To explore the clinical efficacy of membrane anatomy in laparoscopic radical resection of rectal cancer.Methods A retrospective cohort study was conducted,involving 33 patients who underwent laparoscopic radical resection of rectal cancer guided by membrane anatomy(observation group)from April 2023 to April 2024,compared with 35 patients who underwent traditional total mesorectal excision(control group)from March 2022 to March 2023.Surgical indicators(duration of surgery,intraoperative blood loss,and number of lymph nodes dissected)and postoperative recovery were compared between the two groups.Results There was no statistically significant difference in the operation time between the two groups[(173.8±14.7)min in the observation group vs.(179.1±15.3)min in the control group,t=-1.437,P=0.156].There were also no statistically significant differences in the postoperative hospital stay[(9.4±1.4)d vs.(9.8±2.4)d,t=-0.859,P=0.394]and in the incidence of various complications[12.1%(4/33)vs.20.0%(7/35),χ^(2)=0.778,P=0.378].The intraoperative blood loss in the observation group was significantly less than that in the control group[(34.6±10.8)ml vs.(81.0±14.3)ml,t=-15.156,P=0.000].The number of lymph nodes dissected in the observation group was significantly higher than that in the control group(19.8±1.3 vs.12.4±1.9,t=18.684,P=0.000).The time to first flatus after surgery in the observation group was shorter than that in the control group[(50.4±6.5)h vs.(55.2±8.9)h,t=-2.557,P=0.013].The postoperative drainage time in the observation group was shorter than that in the control group[(5.9±1.1)d vs.(6.5±1.0)d,t=-2.532,P=0.014].A total of 66 cases were followed up for 8-39 months,with a median time of 25 months.The observation group had no metastasis,local recurrence,or death,while the control group had 1 case of liver metastasis,1 case of local recurrence,and 1 case of death from other systemic diseases.Conclusions The application of membrane anatomy in laparoscopic radical resection of rectal cancer can ensure complete mesorectal excision,expand the surgical field of view,minimize intraoperative bleeding,and enhance the thoroughness of lymph node dissection,thereby improving surgical quality.However,it fails to shorten the operation time.
作者
刘楠
苏帅
刘文超
陈德兴
刘奇
Liu Nan;Su Shuai;Liu Wenchao(Department of General Surgery,Qianwei Hospital of Jilin Province,Changchun 130012,China)
出处
《中国微创外科杂志》
北大核心
2025年第11期647-653,共7页
Chinese Journal of Minimally Invasive Surgery
基金
吉林省卫生与健康技术创新项目(2023LC079)。
关键词
膜解剖理念
腹腔镜
直肠癌根治术
Membrane anatomy
Laparoscopy
Radical resection of rectal cancer
